Provider Demographics
NPI:1548983224
Name:BALM OF GILEAD COUNSELING SERVICES
Entity type:Organization
Organization Name:BALM OF GILEAD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLADAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLUWALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-632-8041
Mailing Address - Street 1:2064 BURSON DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5304
Mailing Address - Country:US
Mailing Address - Phone:434-632-8041
Mailing Address - Fax:
Practice Address - Street 1:111 MILL CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1098
Practice Address - Country:US
Practice Address - Phone:434-632-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PISTEUO COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770240228OtherCIGNA
VA1770240228OtherANTHEM