Organization
108 COUNSELING, LLC
Active
Other names
108 Counseling , LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MCNAMARA (CREDENTIALING MANAGER)
(804) 221-2042
Entity
Organization
Contact information
Practice address
8710 CHOCTAW RD STE 6A, NORTH CHESTERFIELD, VA 23235-3472
(646) 256-5103
Mailing address
8710 CHOCTAW RD STE 6A, NORTH CHESTERFIELD, VA 23235-3472
(646) 256-5103
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366985228
—
VA
Enumeration date
04/12/2019
Last updated
04/12/2019
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