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General NPI Number Information
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NPI Number | 1336381516
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Entity Type | Organization
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Legal Business Name | NORTH COUNTY CHRISTIAN COUNSELING SERVICES
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 9279 DELL CT
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City | SAINT LOUIS
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State | MO
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Zip | 63137-1609
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Country | US
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Telephone | 314-520-8859
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Fax | 314-714-6493
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Provider Business Mailing Address
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Address Line | PO BOX 3823
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City | SAINT LOUIS
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State | MO
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Zip | 63136-0423
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Country | US
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Telephone | 314-520-8859
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Fax | 314-714-6493
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. DIANE HOLBROOKS
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Credential | LCSW
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Telephone | 314-520-8859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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