Provider Demographics
NPI:1023317856
Name:COMPREHENSIVE THERAPUETIC ASSESSMENTS AND COUNSELING
Entity type:Organization
Organization Name:COMPREHENSIVE THERAPUETIC ASSESSMENTS AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC
Authorized Official - Phone:334-614-0959
Mailing Address - Street 1:915 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-5821
Mailing Address - Country:US
Mailing Address - Phone:334-614-0959
Mailing Address - Fax:
Practice Address - Street 1:915 12TH ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5821
Practice Address - Country:US
Practice Address - Phone:334-614-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005656251S00000X
AL2786251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health