Provider Demographics
NPI:1699200170
Name:CHRIST CENTERED COMMUNITY COUNSELING PLLC
Entity Type:Organization
Organization Name:CHRIST CENTERED COMMUNITY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-301-6754
Mailing Address - Street 1:2225 FREEDOM DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4035
Mailing Address - Country:US
Mailing Address - Phone:045-377-7757
Mailing Address - Fax:
Practice Address - Street 1:2225 FREEDOM DR STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4035
Practice Address - Country:US
Practice Address - Phone:045-377-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009752251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health