Organization
INTERCEDING CONSULTANT LLC
Active
Other names
INTERCEDING CONSULTANT
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD TILLMAN (CEO)
(804) 301-6410
Entity
Organization
Contact information
Practice address
5412 GLENSIDE DR STE F, RICHMOND, VA 23228-3995
(804) 997-7962
(877) 333-0229
Mailing address
1140 WILKINSON RD, RICHMOND, VA 23227-1623
(804) 997-7962
(877) 333-0229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639566787
—
VA
05
—
1639566789
—
VA
Enumeration date
04/15/2015
Last updated
05/26/2021
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