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General NPI Number Information
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NPI Number | 1457771677
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Entity Type | Organization
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Legal Business Name | DYNAMIC COUNSELING AND CONSULTATION SERVICES
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Dates
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Enumeration Date | 04/27/2014
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 4202 WILLIAMSON PL STE 1
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6760
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Country | US
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Telephone | 618-816-1224
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Fax | 800-335-4761
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Provider Business Mailing Address
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Address Line | 1111 S LINCOLN AVE UNIT 1326
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City | O FALLON
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State | IL
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Zip | 62269-5165
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Country | US
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Telephone | 618-816-1224
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Fax | 800-335-4761
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Authorized Official
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Title or Position | OWNER
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Name | MS. CARRIE CROCKER
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Credential | LCSW
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Telephone | 618-816-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2003032196
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License Number State | MO
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