Provider Demographics
NPI:1912631706
Name:ENCOUNTER COMMUNITY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:ENCOUNTER COMMUNITY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPC, LPC-S, CADC II
Authorized Official - Phone:601-613-1240
Mailing Address - Street 1:1700 W GOVERNMENT STREET, BUILDING B.
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2423
Mailing Address - Country:US
Mailing Address - Phone:601-613-1240
Mailing Address - Fax:
Practice Address - Street 1:1700 W GOVERNMENT STREET, BUILDING B.
Practice Address - Street 2:SUITE 214
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2423
Practice Address - Country:US
Practice Address - Phone:601-613-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1194294546Medicaid