Healthcare Provider Details

I. General information

NPI: 1467635490
Provider Name (Legal Business Name): CHRISTIAN CONNECTION COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CHURCH ST
WINTERSVILLE OH
43953-3701
US

IV. Provider business mailing address

186 TOWNSHIP HIGHWAY 202
BLOOMINGDALE OH
43910-7878
US

V. Phone/Fax

Practice location:
  • Phone: 740-381-5126
  • Fax:
Mailing address:
  • Phone: 740-381-5126
  • Fax: 740-944-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number981144
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI18134
License Number StateOH

VIII. Authorized Official

Name: TERRY L DEHAMER
Title or Position: OWNER
Credential: LISW, LICDC
Phone: 740-381-5126