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General NPI Number Information
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NPI Number | 1821234469
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Entity Type | Organization
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Legal Business Name | THE VILLAGE BUILDERS COMMUNITY DEVELOPMENT FOUNDATION
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Dates
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Enumeration Date | 01/04/2009
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Last Update Date | 01/04/2009
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Provider Practice Location Address
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Address Line | 1303 W GORE BLVD SUITE 6
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City | LAWTON
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State | OK
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Zip | 73501-3645
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Country | US
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Telephone | 580-512-9862
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8012
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City | LAWTON
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State | OK
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Zip | 73506-2012
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Country | US
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Telephone | 580-512-9862
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDREA L FARMER
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Credential | NCC,LPC,LMFT,LADC
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Telephone | 580-512-9862
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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 | 3171
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License Number State | OK
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