Provider Demographics
NPI:1679293476
Name:WEISS LAKE COUNSELING SERVICES
Entity Type:Organization
Organization Name:WEISS LAKE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ALC, NCC
Authorized Official - Phone:256-927-5920
Mailing Address - Street 1:839 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1235
Mailing Address - Country:US
Mailing Address - Phone:256-927-5920
Mailing Address - Fax:256-927-3205
Practice Address - Street 1:839 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1235
Practice Address - Country:US
Practice Address - Phone:256-927-5920
Practice Address - Fax:256-927-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty