Provider Demographics
NPI:1720192735
Name:THE COUNSELING CENTER
Entity Type:Organization
Organization Name:THE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-979-0447
Mailing Address - Street 1:102 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-1302
Mailing Address - Country:US
Mailing Address - Phone:276-979-0447
Mailing Address - Fax:276-979-0480
Practice Address - Street 1:102 CHURCH ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-1302
Practice Address - Country:US
Practice Address - Phone:276-979-0447
Practice Address - Fax:276-979-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA257837OtherMTN. STATE BC/BS
VA171897OtherCOMPSYCH
VA01843900OtherMAGELLAN
VADA0938OtherPALMETTO GBA
VA257837OtherMTN. STATE BC/BS