Healthcare Provider Details

I. General information

NPI: 1104193697
Provider Name (Legal Business Name): FOUNDATIONS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SANDERS ST
ATHENS AL
35611-1420
US

IV. Provider business mailing address

202 SANDERS ST
ATHENS AL
35611-1420
US

V. Phone/Fax

Practice location:
  • Phone: 256-497-1790
  • Fax: 256-998-5500
Mailing address:
  • Phone: 256-497-1790
  • Fax: 256-998-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0093-2342C
License Number StateAL

VIII. Authorized Official

Name: WILL JOHNSON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 256-497-1790