Provider Demographics
NPI:1336473602
Name:AT THE TABLE COUNSELING, PLLC
Entity Type:Organization
Organization Name:AT THE TABLE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SONEAKQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-684-5867
Mailing Address - Street 1:2300 VALLEY VIEW LN STE 338
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-1776
Mailing Address - Country:US
Mailing Address - Phone:214-684-5867
Mailing Address - Fax:214-393-4793
Practice Address - Street 1:2300 VALLEY VIEW LN STE 338
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-1776
Practice Address - Country:US
Practice Address - Phone:214-684-5867
Practice Address - Fax:214-393-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20024251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194340901Medicaid