Provider Demographics
NPI:1972198067
Name:BALM OF GILEAD CHRISTIAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BALM OF GILEAD CHRISTIAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNORBAH-OWHONDAH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:225-361-9576
Mailing Address - Street 1:8542 SIEGEN LN STE 6
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1940
Mailing Address - Country:US
Mailing Address - Phone:225-361-9576
Mailing Address - Fax:
Practice Address - Street 1:8542 SIEGEN LN STE 6
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1940
Practice Address - Country:US
Practice Address - Phone:225-361-9576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000000Medicaid
LA000000000Medicaid