Provider Demographics
NPI:1558091785
Name:THE OLIVE BRANCH COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:THE OLIVE BRANCH COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC NCC
Authorized Official - Phone:205-259-8308
Mailing Address - Street 1:549 1ST ST N STE C
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8755
Mailing Address - Country:US
Mailing Address - Phone:205-259-8308
Mailing Address - Fax:
Practice Address - Street 1:549 1ST ST N STE C
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8755
Practice Address - Country:US
Practice Address - Phone:205-259-8308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OLIVE BRANCH COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL8590OtherBCBS, CIGNA, VIVA