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Organization
FOUNDATIONS FOR LIFE COUNSELING SERVICES, LLC
Active
Organization
FOUNDATIONS FOR LIFE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MALLARD GEORGE LPC (OWNER)
(804) 467-2606
Entity
Organization
Contact information
Practice address
4914 FITZHUGH AVE STE 102, RICHMOND, VA 23230-3534
(804) 377-3955
(804) 377-3956
Mailing address
4914 FITZHUGH AVE STE 102, RICHMOND, VA 23230-3534
(804) 377-3955
(804) 377-3956
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005415501
—
VA
05
—
005415781
—
VA
Enumeration date
04/25/2007
Last updated
12/13/2024
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