Organization
FOUNDATIONS FOR LIFE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MALLARD GEORGE LPC (OWNER)
(804) 467-2606
Entity
Organization
Contact information
Practice address
4914 FITZHUGH AVE STE 102, RICHMOND, VA 23230-3534
(804) 377-3955
(804) 377-3956
Mailing address
4914 FITZHUGH AVE STE 102, RICHMOND, VA 23230-3534
(804) 377-3955
(804) 377-3956
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005415501
—
VA
05
—
005415781
—
VA
Enumeration date
04/25/2007
Last updated
12/13/2024
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