Provider Demographics
NPI:1821234469
Name:THE VILLAGE BUILDERS COMMUNITY DEVELOPMENT FOUNDATION
Entity Type:Organization
Organization Name:THE VILLAGE BUILDERS COMMUNITY DEVELOPMENT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:NCC,LPC,LMFT,LADC
Authorized Official - Phone:580-512-9862
Mailing Address - Street 1:PO BOX 8012
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-2012
Mailing Address - Country:US
Mailing Address - Phone:580-512-9862
Mailing Address - Fax:
Practice Address - Street 1:1303 W GORE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3645
Practice Address - Country:US
Practice Address - Phone:580-512-9862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3171251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health