Provider Demographics
NPI:1811040264
Name:CHRISTIAN FOCUS COUNSELING SERVICE
Entity Type:Organization
Organization Name:CHRISTIAN FOCUS COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-563-9908
Mailing Address - Street 1:PO BOX 189107
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28218-9107
Mailing Address - Country:US
Mailing Address - Phone:704-563-9908
Mailing Address - Fax:
Practice Address - Street 1:4401 E INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7485
Practice Address - Country:US
Practice Address - Phone:704-563-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-257251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005409Medicaid