| Evergreen Counseling Services Llc | |
|
4318 Old Hundred Rd Ste C Chester VA 23831-4231 | |
| (804) 621-5572 | |
| (804) 821-1253 |
| Full Name | Evergreen Counseling Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4318 Old Hundred Rd Ste C, Chester, Virginia |
| Authorized Official Name and Position | Cristal R Jenkins (OWNER) |
| Authorized Official Contact | 8046215572 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Counseling Services Llc 4101 Sunset Ave Chester VA 23831-6616 Ph: (804) 821-1253 | Evergreen Counseling Services Llc 4318 Old Hundred Rd Ste C Chester VA 23831-4231 Ph: (804) 621-5572 |
| NPI Number | 1629725478 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Medicare PECOS PAC ID | 1456736388 |
|---|---|
| Medicare Enrollment ID | O20220913004125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629725478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Cristal Rose Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134374747 PECOS PAC ID: 2365827292 Enrollment ID: I20220913004157 |
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