Provider Demographics
NPI:1811299514
Name:CHRISTIAN COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-528-1278
Mailing Address - Street 1:1120 SUMMER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9403
Mailing Address - Country:US
Mailing Address - Phone:901-528-1278
Mailing Address - Fax:901-721-6044
Practice Address - Street 1:1169 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2221
Practice Address - Country:US
Practice Address - Phone:901-528-1278
Practice Address - Fax:901-721-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN04631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty