1043376866 NPI number — FAMILY COUNSELING CENTER FOR RECOVERY

Table of content: (NPI 1043376866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043376866 NPI number — FAMILY COUNSELING CENTER FOR RECOVERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY COUNSELING CENTER FOR RECOVERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043376866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 RADFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-354-1996
Provider Business Mailing Address Fax Number:
804-354-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4906 RADFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-354-1996
Provider Business Practice Location Address Fax Number:
804-354-5516
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADCOCK
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
804-354-1996

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  746 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 746 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2421212 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 783408000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 303602 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184832 . This is a "COMPYSCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 144252 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2204983 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 301263 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 527132 . This is a "VALUE OPTION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1021282 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 43014000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7805742 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7947214 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 89403M . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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