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General NPI Number Information
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NPI Number | 1003476714
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Entity Type | Organization
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Legal Business Name | GROWING IN THE DARK COUNSELING SERVICES
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 402 3RD AVE SW
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City | REFORM
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State | AL
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Zip | 35481
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Country | US
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Telephone | 205-219-2293
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Fax |
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Provider Business Mailing Address
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Address Line | 904 7TH STREET ALT NW
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City | REFORM
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State | AL
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Zip | 35481
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Country | US
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Telephone | 205-219-2293
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MR. CHRISTOPHER GOSA
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Credential | LPC
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Telephone | 205-219-2293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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