Provider Demographics
NPI:1427762541
Name:BALM OF GILEAD COUNSELING SERVICES
Entity type:Organization
Organization Name:BALM OF GILEAD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLADAYO
Authorized Official - Middle Name:OLAKUNLE
Authorized Official - Last Name:OLUWALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-632-8041
Mailing Address - Street 1:2064 BURSON DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5304
Mailing Address - Country:US
Mailing Address - Phone:434-632-8041
Mailing Address - Fax:
Practice Address - Street 1:6350 CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4107
Practice Address - Country:US
Practice Address - Phone:434-632-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty