| Life Enrichment Counseling Center, Inc. | |
|
7230 Heritage Village Plz Suite 202 Gainesville VA 20155-3053 | |
| (703) 754-0636 | |
| (703) 754-0646 |
| Full Name | Life Enrichment Counseling Center, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 7230 Heritage Village Plz, Gainesville, Virginia |
| Authorized Official Name and Position | Beverley Elaine Boothe-mooring (PRESIDENT) |
| Authorized Official Contact | 7037540636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enrichment Counseling Center, Inc. 7230 Heritage Village Plz Suite 202 Gainesville VA 20155-3053 Ph: (703) 754-0636 | Life Enrichment Counseling Center, Inc. 7230 Heritage Village Plz Suite 202 Gainesville VA 20155-3053 Ph: (703) 754-0636 |
| NPI Number | 1851517163 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 01/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851517163 | NPI | - | NPPES |
| 187850 | Other | VA | ANTHEM # |
| NO730001 | Other | MD | CAREFIRST |
| 298447345 | Other | VA | UBH # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904005909 (Virginia) | Primary |
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