Healthcare Provider Details

I. General information

NPI: 1154585396
Provider Name (Legal Business Name): ENTERPRISE PROFESSIONAL COUNSELING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316
US

IV. Provider business mailing address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316
US

V. Phone/Fax

Practice location:
  • Phone: 334-237-3838
  • Fax: 334-489-4606
Mailing address:
  • Phone: 334-237-3838
  • Fax: 334-489-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER M. SMITH
Title or Position: OWNER
Credential: LPC
Phone: 334-237-3838