Provider Demographics
NPI:1669050431
Name:SYLACAUGA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SYLACAUGA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRIE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:CARMACK AARON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-267-4746
Mailing Address - Street 1:13 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2939
Mailing Address - Country:US
Mailing Address - Phone:256-626-8095
Mailing Address - Fax:844-605-1912
Practice Address - Street 1:13 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2939
Practice Address - Country:US
Practice Address - Phone:256-626-8095
Practice Address - Fax:844-605-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty