Provider Demographics
NPI:1972774677
Name:ALPHA OMEGA CHRISTIAN COUNSELING P C
Entity Type:Organization
Organization Name:ALPHA OMEGA CHRISTIAN COUNSELING P C
Other - Org Name:ALPHA OMEGA CHRISTIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:618-698-6299
Mailing Address - Street 1:1477 SCHWARZ MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6710
Mailing Address - Country:US
Mailing Address - Phone:618-698-6299
Mailing Address - Fax:
Practice Address - Street 1:1914 ESIC DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3946
Practice Address - Country:US
Practice Address - Phone:618-698-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140253103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty