Organization
4 A KINDER CLASS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY LYN HANCOCK SR. (EXEC. VICE PRESIDENT)
(410) 842-3978
Entity
Organization
Contact information
Practice address
13492 CANTERBURY RD, MONTPELIER, VA 23192-2622
(410) 842-3978
(804) 883-5556
Mailing address
PO BOX 37, MONTPELIER, VA 23192-0037
(410) 842-3978
(804) 883-5556
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701004671
VA
101YM0800X
Mental Health Counselor
Primary
0701004671
VA
101YP2500X
Professional Counselor
0701004671
VA
101YS0200X
School Counselor
0701004671
VA
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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