Provider Demographics
NPI:1396018750
Name:FOUNDATIONS COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:FOUNDATIONS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, PIP
Authorized Official - Phone:256-497-3147
Mailing Address - Street 1:22176 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2318
Mailing Address - Country:US
Mailing Address - Phone:256-497-3147
Mailing Address - Fax:256-230-0541
Practice Address - Street 1:100 HINE ST S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2302
Practice Address - Country:US
Practice Address - Phone:256-497-3147
Practice Address - Fax:256-230-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2342C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty