Provider Demographics
NPI:1003972241
Name:DESERT ROCK COMMUNITY CHURCH
Entity Type:Organization
Organization Name:DESERT ROCK COMMUNITY CHURCH
Other - Org Name:DESERT ROCK CHRISTIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-752-7992
Mailing Address - Street 1:7307 S HARL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4367
Mailing Address - Country:US
Mailing Address - Phone:480-752-7992
Mailing Address - Fax:480-422-4450
Practice Address - Street 1:7307 S HARL AVE STE 6
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4367
Practice Address - Country:US
Practice Address - Phone:480-752-7992
Practice Address - Fax:480-422-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty