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Organization
LIFE ENRICHMENT COUNSELING CENTER, INC.
Active
Organization
LIFE ENRICHMENT COUNSELING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLEY ELAINE BOOTHE-MOORING LCSW (PRESIDENT)
(703) 754-0636
Entity
Organization
Contact information
Practice address
7230 HERITAGE VILLAGE PLZ, SUITE 202, GAINESVILLE, VA 20155-3053
(703) 754-0636
(703) 754-0646
Mailing address
7230 HERITAGE VILLAGE PLZ, SUITE 202, GAINESVILLE, VA 20155-3053
(703) 754-0636
(703) 754-0646
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005909
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
187850
ANTHEM #
VA
01
—
298447345
UBH #
VA
01
—
NO730001
CAREFIRST
MD
Enumeration date
04/17/2007
Last updated
01/19/2012
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