Healthcare Provider Details

I. General information

NPI: 1316635212
Provider Name (Legal Business Name): AGAPE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S 8TH AVE
BRANDON SD
57005-1772
US

IV. Provider business mailing address

700 S 8TH AVE
BRANDON SD
57005-1772
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-4722
  • Fax:
Mailing address:
  • Phone: 605-582-4722
  • Fax: 605-582-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIN L SANFORD
Title or Position: COUNSELOR
Credential: LPC-MH
Phone: 605-359-6432