Provider Demographics
NPI:1619338571
Name:CARE COUNSELING CLINIC, LLC
Entity Type:Organization
Organization Name:CARE COUNSELING CLINIC, LLC
Other - Org Name:CARE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-816-7378
Mailing Address - Street 1:429 SW 5TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5037
Mailing Address - Country:US
Mailing Address - Phone:208-816-7378
Mailing Address - Fax:208-816-7385
Practice Address - Street 1:429 SW 5TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5037
Practice Address - Country:US
Practice Address - Phone:208-816-7378
Practice Address - Fax:208-816-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-355981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20009071OtherNORIDIAN HEALTH CARE SOLUTIONS