| Innovative Counseling Group | |
|
302 Turner Rd Ste F North Chesterfield VA 23225-6433 | |
| (804) 658-6760 | |
| (804) 658-7195 |
| Full Name | Innovative Counseling Group |
|---|---|
| Speciality | Counselor - Professional |
| Location | 302 Turner Rd Ste F, North Chesterfield, Virginia |
| Authorized Official Name and Position | Johnathan Hayes Weaver (OWNER) |
| Authorized Official Contact | 8046586760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Counseling Group Po Box 38031 Henrico VA 23231-0831 Ph: (804) 804-6586 | Innovative Counseling Group 302 Turner Rd Ste F North Chesterfield VA 23225-6433 Ph: (804) 658-6760 |
| NPI Number | 1306465257 |
|---|---|
| Provider Enumeration Date | 04/10/2020 |
| Last Update Date | 04/10/2020 |
| Certification Date | 04/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306465257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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