Provider Demographics
NPI: | 1497468870 |
---|---|
Name: | THE COUNSELING DEN CHRISTIAN COUNSELING CENTER |
Entity Type: | Organization |
Organization Name: | THE COUNSELING DEN CHRISTIAN COUNSELING CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ERICA |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | HOLMES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | EDD, LPC |
Authorized Official - Phone: | 901-647-9167 |
Mailing Address - Street 1: | 7145 SWINNEA RD STE 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTHAVEN |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38671-6380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-647-9167 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7145 SWINNEA RD STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | SOUTHAVEN |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38671-6380 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-647-9167 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-01-02 |
Last Update Date: | 2023-01-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Multi-Specialty | |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |