1235418773 NPI number — C & C COUNSELING SERVICES INC

Table of content: (NPI 1235418773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235418773 NPI number — C & C COUNSELING SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C & C COUNSELING SERVICES INC
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:
1235418773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 DUNBAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22556-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-840-5951
Provider Business Mailing Address Fax Number:
540-659-7270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CORPORATE DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554-4889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-840-5951
Provider Business Practice Location Address Fax Number:
540-659-7270
Provider Enumeration Date:
08/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CESSNA
Authorized Official First Name:
SUNDRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/COUNSELOR
Authorized Official Telephone Number:
540-840-5951

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701004636 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004945247 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235418773 . This is a "NPI#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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