Healthcare Provider Details

I. General information

NPI: 1023253267
Provider Name (Legal Business Name): CARSON CITY COMMUNITY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SOUTH PRATT ST
CARSON CITY NV
89701-4755
US

IV. Provider business mailing address

205 SOUTH PRATT ST
CARSON CITY NV
89701-4755
US

V. Phone/Fax

Practice location:
  • Phone: 775-882-3945
  • Fax: 775-882-6126
Mailing address:
  • Phone: 775-882-3945
  • Fax: 775-882-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0900002345
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0900002345
License Number StateNV

VIII. Authorized Official

Name: DEANNA JANELL TORRES
Title or Position: BILLING MANGER
Credential:
Phone: 775-882-3945