1174627376 NPI number — COMPLETE COUNSELING SERIVCES, INC.

Table of content: (NPI 1174627376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174627376 NPI number — COMPLETE COUNSELING SERIVCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE COUNSELING SERIVCES, 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:
6
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:
1174627376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24523-0628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-586-8146
Provider Business Mailing Address Fax Number:
540-587-7647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 TURKEY MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24523-6635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-586-8146
Provider Business Practice Location Address Fax Number:
540-587-7647
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANTOOTH
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
540-586-8146

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904003979 , 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: 084297M . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 183482 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 084296M . This is a "SOUTHERN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010219779 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233212 . This is a "COMPSYCH CORP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010219779 . This is a "VIRGINIA PREMEIR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2278616 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 338400 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2119434 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 344311 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7664336 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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