Provider Demographics
NPI:1457827131
Name:TWIN COUNTY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TWIN COUNTY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-233-8451
Mailing Address - Street 1:487 STONE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6227
Mailing Address - Country:US
Mailing Address - Phone:276-233-3764
Mailing Address - Fax:276-236-8880
Practice Address - Street 1:487 STONE BROOK DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6227
Practice Address - Country:US
Practice Address - Phone:276-233-3763
Practice Address - Fax:276-236-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601027524Medicaid