Provider Demographics
NPI:1477312403
Name:VILLAGE CHURCH, INC.
Entity Type:Organization
Organization Name:VILLAGE CHURCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-843-4883
Mailing Address - Street 1:3216 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1597
Mailing Address - Country:US
Mailing Address - Phone:818-843-4883
Mailing Address - Fax:818-843-3423
Practice Address - Street 1:3216 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1597
Practice Address - Country:US
Practice Address - Phone:818-843-4883
Practice Address - Fax:818-843-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty