Healthcare Provider Details

I. General information

NPI: 1942065198
Provider Name (Legal Business Name): PEACE CENTER COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 CATHERINE CT STE 2A
AUBURN AL
36830-5735
US

IV. Provider business mailing address

2613 WESTON ST
AUBURN AL
36832-3671
US

V. Phone/Fax

Practice location:
  • Phone: 334-610-0169
  • Fax: 334-591-2678
Mailing address:
  • Phone: 864-609-7396
  • Fax: 334-591-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. VIRGINIA H YOUNG
Title or Position: CLINIC DIRECTOR
Credential: ALC
Phone: 864-609-7396