Provider Demographics
NPI:1003936899
Name:COMMUNITY COUNSELING CENTER OF MADISON, WI, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER OF MADISON, WI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-833-5880
Mailing Address - Street 1:6629 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3037
Mailing Address - Country:US
Mailing Address - Phone:608-833-5880
Mailing Address - Fax:608-829-3787
Practice Address - Street 1:6629 UNIVERSITY AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3037
Practice Address - Country:US
Practice Address - Phone:608-833-5880
Practice Address - Fax:608-829-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42165100Medicaid