Provider Demographics
NPI:1871101204
Name:BEYOND THE COUCH, LLC
Entity type:Organization
Organization Name:BEYOND THE COUCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:571-310-0538
Mailing Address - Street 1:18138 CAMDENHURST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-6240
Mailing Address - Country:US
Mailing Address - Phone:571-310-0538
Mailing Address - Fax:
Practice Address - Street 1:18138 CAMDENHURST DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-6240
Practice Address - Country:US
Practice Address - Phone:571-310-0538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty