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General NPI Number Information
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NPI Number | 1275967101
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Entity Type | Organization
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Legal Business Name | VCPHCS II LLC
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 1105 MEMORIAL DR SUITE 101
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City | DENISON
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State | TX
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Zip | 75020-2177
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Country | US
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Telephone | 972-391-4254
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Fax | 903-464-0559
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Provider Business Mailing Address
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Address Line | 1105 MEMORIAL DR SUITE 101
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City | DENISON
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State | TX
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Zip | 75020-2177
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Country | US
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Telephone | 972-391-4254
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Fax | 903-464-0559
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Authorized Official
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Title or Position | COUNSELOR
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Name | CARMON LARAINE ALEXANDER
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Credential | LCDC
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Telephone | 972-391-4254
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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 | 10560
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License Number State | TX
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