Organization
COMPASSIONATE HEARTSPACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JO S MCGOVERN LCSW (OWNER)
(757) 345-8651
Entity
Organization
Contact information
Practice address
104 N HENRY ST, WILLIAMSBURG, VA 23185-4137
(757) 345-8651
Mailing address
312 NOTTINGHAM RD, WILLIAMSBURG, VA 23185-4913
(757) 345-8651
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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