| Interceding Consultant | |
|
5412 Glenside Dr Ste F Richmond VA 23228-3995 | |
| (804) 997-7962 | |
| (877) 333-0229 |
| Full Name | Interceding Consultant |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 5412 Glenside Dr Ste F, Richmond, Virginia |
| Authorized Official Name and Position | Edward Tillman (CEO) |
| Authorized Official Contact | 8043016410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Interceding Consultant 1140 Wilkinson Rd Richmond VA 23227-1623 Ph: (804) 997-7962 | Interceding Consultant 5412 Glenside Dr Ste F Richmond VA 23228-3995 Ph: (804) 997-7962 |
| NPI Number | 1639566789 |
|---|---|
| Provider Enumeration Date | 04/15/2015 |
| Last Update Date | 05/26/2021 |
| Certification Date | 05/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639566789 | NPI | - | NPPES |
| 1639566789 | Medicaid | VA | |
| 1639566787 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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