Provider Demographics
NPI:1447005343
Name:PROMINENT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PROMINENT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, QMHP
Authorized Official - Phone:434-222-0823
Mailing Address - Street 1:555 SOUTHLAKE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3060
Mailing Address - Country:US
Mailing Address - Phone:804-716-8908
Mailing Address - Fax:866-216-5506
Practice Address - Street 1:555 SOUTHLAKE BLVD STE D
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3060
Practice Address - Country:US
Practice Address - Phone:434-222-0823
Practice Address - Fax:866-216-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty