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General NPI Number Information
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NPI Number | 1770840464
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Entity Type | Organization
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Legal Business Name | VERNON COMMUNITY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 282 ALEXANDRIA HWY
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City | LEESVILLE
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State | LA
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Zip | 71446-2146
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Country | US
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Telephone | 337-213-2393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1726
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City | LEESVILLE
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State | LA
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Zip | 71496-1726
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Country | US
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Telephone | 337-213-2393
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Fax | 337-404-3976
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Authorized Official
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Title or Position | CEO
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Name | DEBRA LOUISE HOLLER
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Credential | PH.D.
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Telephone | 337-213-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFT368
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License Number State | LA
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