Provider Demographics
NPI:1912447095
Name:CIRCLE OF FRIENDS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CIRCLE OF FRIENDS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINNEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-532-9214
Mailing Address - Street 1:700 PIERRE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-2725
Mailing Address - Country:US
Mailing Address - Phone:318-532-9214
Mailing Address - Fax:318-603-6622
Practice Address - Street 1:700 PIERRE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2725
Practice Address - Country:US
Practice Address - Phone:318-532-9214
Practice Address - Fax:318-603-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 172V00000X, 175T00000X, 251B00000X, 251S00000X, 252Y00000X, 251S00000X, 106E00000X, 175T00000X
LA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1912447095Medicaid