Healthcare Provider Details

I. General information

NPI: 1609470665
Provider Name (Legal Business Name): VILLAGE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 KEITH VALLEY RD
COHUTTA GA
30710-7767
US

IV. Provider business mailing address

4000 KEITH VALLEY RD
COHUTTA GA
30710-7767
US

V. Phone/Fax

Practice location:
  • Phone: 423-255-4367
  • Fax:
Mailing address:
  • Phone: 423-255-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ACEA STARKS
Title or Position: LPC / OWNER
Credential: LPC
Phone: 423-255-4367