Provider Demographics
NPI:1699371468
Name:CONSCIOUS LIVING COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CONSCIOUS LIVING COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-221-1137
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1132
Mailing Address - Country:US
Mailing Address - Phone:256-403-1406
Mailing Address - Fax:
Practice Address - Street 1:1302 NOBLE ST STE 2H
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4677
Practice Address - Country:US
Practice Address - Phone:256-402-1406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)