Provider Demographics
NPI:1831489764
Name:GEM CITY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:GEM CITY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:WHISENHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LICDCCS
Authorized Official - Phone:937-760-2441
Mailing Address - Street 1:PO BOX 292012
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0012
Mailing Address - Country:US
Mailing Address - Phone:937-760-2441
Mailing Address - Fax:513-826-9309
Practice Address - Street 1:2611 WAYNE AVE
Practice Address - Street 2:BUILDING 61
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1833
Practice Address - Country:US
Practice Address - Phone:937-760-2441
Practice Address - Fax:513-826-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH913119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty