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General NPI Number Information
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NPI Number | 1396312658
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Entity Type | Organization
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Legal Business Name | IMPACT COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 3613 WILLIAMS DR STE 302
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City | GEORGETOWN
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State | TX
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Zip | 78628-1369
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Country | US
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Telephone | 512-713-9886
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Fax | 737-277-5546
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Provider Business Mailing Address
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Address Line | 3613 WILLIAMS DR STE 302
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City | GEORGETOWN
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State | TX
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Zip | 78628-1369
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Country | US
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Telephone | 512-713-9886
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Fax | 737-277-5546
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CANDI GADISON
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Credential | LCSW
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Telephone | 512-713-9886
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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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