Provider Demographics
NPI:1417470287
Name:DYNAMIC COUNSELING AND COACHING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DYNAMIC COUNSELING AND COACHING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:SHUMATE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-777-1268
Mailing Address - Street 1:24654 N LAKE PLEASANT PKWY
Mailing Address - Street 2:# 103-328
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1359
Mailing Address - Country:US
Mailing Address - Phone:602-777-1268
Mailing Address - Fax:
Practice Address - Street 1:13201 N 35TH AVE STE 5B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1231
Practice Address - Country:US
Practice Address - Phone:602-777-1268
Practice Address - Fax:866-251-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15992101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1891248381OtherNPI
AZ230114Medicaid