Provider Demographics
NPI:1841814639
Name:THE CHILDREN AND ADULT COUNSELING CENTER LLC
Entity type:Organization
Organization Name:THE CHILDREN AND ADULT COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-627-1099
Mailing Address - Street 1:930 MAJESTIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4055
Mailing Address - Country:US
Mailing Address - Phone:757-627-1099
Mailing Address - Fax:757-640-0954
Practice Address - Street 1:930 MAJESTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-627-1099
Practice Address - Fax:757-640-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty