Provider Demographics
NPI:1356635759
Name:COMMUNITY CENTERED COUNSELING SERVICES, LLC.
Entity Type:Organization
Organization Name:COMMUNITY CENTERED COUNSELING SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:VILMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:563-349-1638
Mailing Address - Street 1:2711 W 63RD ST.
Mailing Address - Street 2:STE 3
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806
Mailing Address - Country:US
Mailing Address - Phone:563-388-1039
Mailing Address - Fax:563-388-1041
Practice Address - Street 1:2711 W 63RD ST.
Practice Address - Street 2:STE 3
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806
Practice Address - Country:US
Practice Address - Phone:563-388-1039
Practice Address - Fax:563-388-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03801251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health