Provider Demographics
NPI:1295572246
Name:MIDDLE PENINSULA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MIDDLE PENINSULA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:804-201-3604
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128-0611
Mailing Address - Country:US
Mailing Address - Phone:804-201-3604
Mailing Address - Fax:855-440-1404
Practice Address - Street 1:12156 FOX MILL RUN LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-3056
Practice Address - Country:US
Practice Address - Phone:804-201-3604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty