Provider Demographics
NPI:1417308842
Name:I AM CHRISTIAN COUNSELING SERVICE
Entity type:Organization
Organization Name:I AM CHRISTIAN COUNSELING SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:754-423-7127
Mailing Address - Street 1:3821 NW 7TH PL
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6318
Mailing Address - Country:US
Mailing Address - Phone:754-423-7127
Mailing Address - Fax:954-229-4491
Practice Address - Street 1:3821 NW 7TH PL
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-6318
Practice Address - Country:US
Practice Address - Phone:754-423-7127
Practice Address - Fax:954-229-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17830103K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17830OtherNCCA