Provider Demographics
NPI:1164554887
Name:COMMUNITY CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:COMMUNITY CHRISTIAN COUNSELING CENTER
Other - Org Name:CHAPEL BY THE LAKE SAMARITAN COUNSELING CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF BOARD
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:BELFLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-789-2595
Mailing Address - Street 1:PO BOX 211207
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821
Mailing Address - Country:US
Mailing Address - Phone:907-789-9055
Mailing Address - Fax:907-789-2917
Practice Address - Street 1:11024 AUKE LAKE WAY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-789-9055
Practice Address - Fax:907-789-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK299221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty