1720192735 NPI number — THE COUNSELING CENTER

Table of content: (NPI 1720192735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720192735 NPI number — THE COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720192735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAZEWELL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24651-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-979-0447
Provider Business Mailing Address Fax Number:
276-979-0480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24651-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-979-0447
Provider Business Practice Location Address Fax Number:
276-979-0480
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAVENS
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
276-979-0447

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 257837 . This is a "MTN. STATE BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 171897 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 01843900 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: DA0938 . This is a "PALMETTO GBA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".