Provider Demographics
NPI:1417265950
Name:EMINENCE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EMINENCE COUNSELING SERVICES, LLC
Other - Org Name:DIVERSITY COUNSELING AND EDUCATION CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASIUS
Authorized Official - Middle Name:UMUNNAKWE
Authorized Official - Last Name:OHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-913-6131
Mailing Address - Street 1:11111 E. MISSISSIPPI AVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4239
Mailing Address - Country:US
Mailing Address - Phone:303-296-2350
Mailing Address - Fax:303-296-2450
Practice Address - Street 1:11111 E. MISSISSIPPI AVE SUITE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4239
Practice Address - Country:US
Practice Address - Phone:303-296-2350
Practice Address - Fax:303-296-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1663-00251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149094Medicaid