Provider Demographics
NPI:1861471344
Name:ABINGDON CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:ABINGDON CHRISTIAN COUNSELING
Other - Org Name:WILLIAM B HAYNES JR M ED LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:M ED LPC
Authorized Official - Phone:276-971-9715
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1441
Mailing Address - Country:US
Mailing Address - Phone:276-971-9715
Mailing Address - Fax:276-739-7926
Practice Address - Street 1:274 PARK ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24212
Practice Address - Country:US
Practice Address - Phone:276-971-9715
Practice Address - Fax:276-739-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5414601Medicaid