Organization · NPI-2

Boss Inner Child Counseling, LLC

Community/Behavioral Health · Newport News, VA

NPI number1962069526

StatusActive

Last updated in NPPESMay 20, 2019

Details

NPI: 1962069526
Entity type: Organization (NPI-2)
Legal business name: Boss Inner Child Counseling, LLC
Organization subpart: No
Enumeration date: May 20, 2019
Last updated: May 20, 2019

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251S00000X	Community/Behavioral Health	–	–	Yes
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–
261QM0850X	Clinic/Center, Adult Mental Health	–	–
261QM0855X	Clinic/Center, Adolescent and Children Mental Health	–	–

Practice location

14203 Old Courthouse Way
Suite B
Newport News, VA 23602

Phone 757-893-0321

Mailing address

110 Coliseum Crossing
#138
Hampton, VA 23666-5962

Phone 757-893-0321

Authorized official

Ingrid Marie Bornia
Owner And Ceo
7578930321

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