POLING THERAPEUTIC GROUP LLC — NPI 1104417948 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1104417948

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

101YP2500X (CMS E2)

Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor

Box 32 Service Location & ZIP+4

3617 BUTTERMILK CREEK RD, ROCKINGHAM, VA, 22802-1022

✓ 9-Digit EDI 837 ZIP+4 (22802-1022)

Practice Phone & Referral Fax

(540) 830-1777

Fax: (540) 466-1770

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104417948 (POLING THERAPEUTIC GROUP LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104417948` (NPI-2 Organization / Facility)
Provider / Legal Name	POLING THERAPEUTIC GROUP LLC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor NUCC Code: `101YP2500X` (Counselor, Professional)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	3617 BUTTERMILK CREEK RD, ROCKINGHAM, VA, 22802-1022
Practice Telephone / Fax	Tel: (540) 830-1777 \| Fax: (540) 466-1770
Administrative Mailing Address	187 VALLEY VIEW AVE, MOUNT SIDNEY, VA, 24467-2205
Enumeration & Last Sync	Enumerated: 2021-02-02 \| CMS Record Updated: 2021-02-02
Authorized Official	JEREMY POLING (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3617 BUTTERMILK CREEK RD, ROCKINGHAM, VA, 22802-1022

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Plain-English Taxonomy & CMS Crosswalk (101YP2500X)

What Does Taxonomy Code 101YP2500X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 101YP2500X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code E2 (Licensed Professional Counselor)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Counselor, Professional for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (POLING THERAPEUTIC GROUP LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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POLING THERAPEUTIC GROUP LLC (NPI #1104417948)