Provider Demographics
NPI:1386081602
Name:SELF ACTUALIZATION COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SELF ACTUALIZATION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONEIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON-BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CSTOP, CSAC, ADC
Authorized Official - Phone:757-287-4990
Mailing Address - Street 1:PO BOX 56555
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-9555
Mailing Address - Country:US
Mailing Address - Phone:757-287-4990
Mailing Address - Fax:
Practice Address - Street 1:900 COMMONWEALTH PL
Practice Address - Street 2:SUITE 200-343
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4517
Practice Address - Country:US
Practice Address - Phone:757-287-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management