Provider Demographics
NPI:1578853859
Name:COMMUNITY COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PREMLATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKONIUK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC, NCC
Authorized Official - Phone:907-631-3606
Mailing Address - Street 1:300 W GRAYBARK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6382
Mailing Address - Country:US
Mailing Address - Phone:907-631-3606
Mailing Address - Fax:
Practice Address - Street 1:300 W GRAYBARK DR
Practice Address - Street 2:UNIT B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6382
Practice Address - Country:US
Practice Address - Phone:907-631-3606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty