Provider Demographics
NPI:1174657712
Name:AGAPE COUNSELING ASSOCIATES INC
Entity Type:Organization
Organization Name:AGAPE COUNSELING ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:585-385-6030
Mailing Address - Street 1:21 WILLOW POND WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-385-6030
Mailing Address - Fax:
Practice Address - Street 1:21 WILLOW POND WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-385-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029236-11041C0700X
NYR030772-11041C0700X
NYR022024-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty