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General NPI Number Information
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NPI Number | 1457758237
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING CENTER LLC
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Dates
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Enumeration Date | 11/22/2014
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 509 W 9TH STREET
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-2133
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Country | US
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Telephone | 270-886-1515
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Fax | 270-885-9232
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Provider Business Mailing Address
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Address Line | 509 W 9TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240
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Country | US
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Telephone | 270-886-1515
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICKEY LEWIS
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Credential |
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Telephone | 270-776-4751
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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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