Provider Demographics
NPI:1902287238
Name:INTELLECTUS COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:INTELLECTUS COUNSELING GROUP, LLC
Other - Org Name:INNOV8TIVE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CITO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:804-245-0727
Mailing Address - Street 1:14403 MICHAELS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6327
Mailing Address - Country:US
Mailing Address - Phone:804-245-0727
Mailing Address - Fax:
Practice Address - Street 1:14403 MICHAELS RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6327
Practice Address - Country:US
Practice Address - Phone:804-245-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA042606060129Medicaid