Healthcare Provider Details

I. General information

NPI: 1720478233
Provider Name (Legal Business Name): ALPHA OMEGA CHRISTIAN COUNSELING; PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 TESSON FERRY RD SUITE 203
SAINT LOUIS MO
63123-6966
US

IV. Provider business mailing address

27 WINDERMERE DR
GLEN CARBON IL
62034-1477
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-2120
  • Fax:
Mailing address:
  • Phone: 618-334-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberIL#180.009256
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID M. KNIGHT
Title or Position: CLINICAL DIRECTOR OF AOCC
Credential: PSYD.
Phone: 314-849-2120