Provider Demographics
NPI:1700550621
Name:IMPACT COACHING CONSULTING AND COUNSELING CENTER LLC
Entity type:Organization
Organization Name:IMPACT COACHING CONSULTING AND COUNSELING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIATHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QMHP-A,C
Authorized Official - Phone:804-243-4939
Mailing Address - Street 1:1248 CARMIA WAY # 1053
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4750
Mailing Address - Country:US
Mailing Address - Phone:804-243-4939
Mailing Address - Fax:
Practice Address - Street 1:1914 BEAVER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-2404
Practice Address - Country:US
Practice Address - Phone:804-243-4939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHE'S ABOUT BUSINESS ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health