Provider Demographics
NPI:1629371125
Name:COMMUNITY COUNSELING SERVICES, PC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PLCAS
Authorized Official - Phone:336-512-0702
Mailing Address - Street 1:515 FIRE TOWER DR
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-6816
Mailing Address - Country:US
Mailing Address - Phone:336-675-2415
Mailing Address - Fax:336-330-0702
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5534
Practice Address - Country:US
Practice Address - Phone:336-512-0702
Practice Address - Fax:336-330-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007411Medicaid