Provider Demographics
NPI:1154073328
Name:LICENSE PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LICENSE PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:251-444-9740
Mailing Address - Street 1:605 BEL AIR BLVD STE 33
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3529
Mailing Address - Country:US
Mailing Address - Phone:251-444-9740
Mailing Address - Fax:251-478-5050
Practice Address - Street 1:605 BEL AIR BLVD STE 33
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3529
Practice Address - Country:US
Practice Address - Phone:251-444-9740
Practice Address - Fax:251-478-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty