Provider Demographics
NPI:1679644967
Name:COUNSELING AND DIAGNOSTIC CENTER, LLC
Entity Type:Organization
Organization Name:COUNSELING AND DIAGNOSTIC CENTER, LLC
Other - Org Name:COUNSELING & DIAGNOSTIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CRATON
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-282-0119
Mailing Address - Street 1:7315 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2126
Mailing Address - Country:US
Mailing Address - Phone:859-282-0119
Mailing Address - Fax:859-282-8018
Practice Address - Street 1:7315 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2126
Practice Address - Country:US
Practice Address - Phone:859-282-0119
Practice Address - Fax:859-282-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP2500X, 103T00000X, 103TC0700X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty