Provider Demographics
NPI:1609470665
Name:VILLAGE COUNSELING CENTER
Entity Type:Organization
Organization Name:VILLAGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ACEA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:423-255-4367
Mailing Address - Street 1:4000 KEITH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COHUTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30710-7767
Mailing Address - Country:US
Mailing Address - Phone:423-255-4367
Mailing Address - Fax:
Practice Address - Street 1:4000 KEITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:COHUTTA
Practice Address - State:GA
Practice Address - Zip Code:30710-7767
Practice Address - Country:US
Practice Address - Phone:423-255-4367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty