Provider Demographics
NPI:1386309045
Name:ACACIA COUNSELING & CONSULTATIVE SERVICES
Entity type:Organization
Organization Name:ACACIA COUNSELING & CONSULTATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-414-4555
Mailing Address - Street 1:11221 ARBOR CREEK DR APT 436
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-0206
Mailing Address - Country:US
Mailing Address - Phone:434-414-4555
Mailing Address - Fax:
Practice Address - Street 1:11221 ARBOR CREEK DR APT 436
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-0206
Practice Address - Country:US
Practice Address - Phone:434-414-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health