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General NPI Number Information
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NPI Number | 1992059117
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Entity Type | Organization
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Legal Business Name | AGAPE CHRISTIAN COUNSELING,LLC
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 500 W HIGHLAND AVE
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City | ROBINSON
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State | IL
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Zip | 62454-1018
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Country | US
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Telephone | 618-544-2517
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W HIGHLAND AVE
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City | ROBINSON
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State | IL
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Zip | 62454-1018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD O. SWISHER
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Credential | LCSW
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Telephone | 618-544-3517
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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 | 149007647
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License Number State | IL
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