Provider Demographics
NPI:1336151679
Name:SAFE TRI COUNTY COMMUNITY CENTER ASSISTING CHILDREN AND WOMEN
Entity Type:Organization
Organization Name:SAFE TRI COUNTY COMMUNITY CENTER ASSISTING CHILDREN AND WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, SWA
Authorized Official - Phone:281-331-2934
Mailing Address - Street 1:406 S GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2432
Mailing Address - Country:US
Mailing Address - Phone:281-331-2934
Mailing Address - Fax:281-585-3709
Practice Address - Street 1:406 S GORDON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2432
Practice Address - Country:US
Practice Address - Phone:281-331-2934
Practice Address - Fax:281-585-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8914101YA0400X
TX16504101YM0800X
TX10226101YM0800X
TX33053104100000X
TX425371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty