| Foundations For Life Counseling Services, Llc | |
|
4914 Fitzhugh Ave Ste 102 Richmond VA 23230-3534 | |
| (804) 377-3955 | |
| (804) 377-3956 |
| Full Name | Foundations For Life Counseling Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4914 Fitzhugh Ave Ste 102, Richmond, Virginia |
| Authorized Official Name and Position | Tara Mallard George (OWNER) |
| Authorized Official Contact | 8044672606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundations For Life Counseling Services, Llc 4914 Fitzhugh Ave Ste 102 Richmond VA 23230-3534 Ph: (804) 377-3955 | Foundations For Life Counseling Services, Llc 4914 Fitzhugh Ave Ste 102 Richmond VA 23230-3534 Ph: (804) 377-3955 |
| NPI Number | 1902025844 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 12/13/2024 |
| Certification Date | 12/13/2024 |
| Medicare PECOS PAC ID | 0143740589 |
|---|---|
| Medicare Enrollment ID | O20250228000411 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902025844 | NPI | - | NPPES |
| 005415781 | Medicaid | VA | |
| 005415501 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tara Mallard George |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215021712 PECOS PAC ID: 1052831492 Enrollment ID: I20250228000502 |
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