Organization
IASIS COUNSELING AND CONSULTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEA A GREEN PH.D,, L.P.C. (CEO)
(804) 882-6163
Entity
Organization
Contact information
Practice address
4609 W BROAD ST, SUITE A2, RICHMOND, VA 23230-3205
(804) 355-2333
(804) 355-3540
Mailing address
1351 BLACKROCK DR, RICHMOND, VA 23225-4101
(804) 882-6163
(804) 355-3540
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701004328
VA
101YM0800X
Mental Health Counselor
Primary
0701004328
VA
101YP1600X
Pastoral Counselor
0701004328
VA
101YP2500X
Professional Counselor
0701004328
VA
Other
Enumeration date
04/15/2013
Last updated
04/22/2013
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