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General NPI Number Information
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NPI Number | 1679934095
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Entity Type | Organization
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Legal Business Name | PREMIER COUNSELING AND COACHING SERVICES, LLC
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Dates
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Enumeration Date | 03/12/2016
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Last Update Date | 03/12/2016
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Provider Practice Location Address
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Address Line | 8595 BEECHMONT AVE 303
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City | CINCINNATI
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State | OH
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Zip | 45255-4783
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Country | US
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Telephone | 513-240-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 8595 BEECHMONT AVE 303
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City | CINCINNATI
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State | OH
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Zip | 45255-4783
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Country | US
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Telephone | 513-240-8558
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. DAVID ELLIS JENNINGS JR.
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Credential |
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Telephone | 513-240-8558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ICDC 882422-CS
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0016706
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0016706
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License Number State | OH
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