Provider Demographics
NPI:1689895625
Name:VCC INC
Entity Type:Organization
Organization Name:VCC INC
Other - Org Name:VALLEY COMMUNITY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-736-0695
Mailing Address - Street 1:1092 EASTLAND DR N STE C
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8442
Mailing Address - Country:US
Mailing Address - Phone:208-736-0695
Mailing Address - Fax:208-735-2482
Practice Address - Street 1:1092 EASTLAND DR N STE C
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8442
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807394700OtherCLINICAL
ID805277500Medicaid
ID805277500OtherPSR
ID805272700Medicaid
ID807394700Medicaid