Provider Demographics
NPI:1851941538
Name:JOE RAPHAEL A PROFESSIONAL MARRIAGE & CHILD COUNSELING CORPORATION
Entity Type:Organization
Organization Name:JOE RAPHAEL A PROFESSIONAL MARRIAGE & CHILD COUNSELING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-779-8215
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-1278
Mailing Address - Country:US
Mailing Address - Phone:425-954-5659
Mailing Address - Fax:425-230-4884
Practice Address - Street 1:5405 MOREHOUSE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4723
Practice Address - Country:US
Practice Address - Phone:425-954-5659
Practice Address - Fax:425-230-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty