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General NPI Number Information
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NPI Number | 1871864470
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Entity Type | Organization
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Legal Business Name | ABC COUNSELING, PLLC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 678 DIEDERICH
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City | RUSSELL
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State | KY
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Zip | 41169-1824
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Country | US
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Telephone | 606-388-4051
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Fax | 606-388-4081
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Provider Business Mailing Address
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Address Line | 978 DIEDERICH BOULEVARD
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City | RUSSELL
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State | KY
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Zip | 41169-1824
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Country | US
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Telephone | 606-388-4051
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Fax | 606-388-4081
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. REBECCA JO NICHOLS
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Credential | M.ED, LPCC
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Telephone | 606-388-4051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | KY LICENSE #1040
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | KY LICENSE #1170
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License Number State | KY
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