MEDICARE: COMFORT PLACE CHRISTIAN COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225912884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT PLACE CHRISTIAN COUNSELING LLC

Provider Business Mailing Address
First Line	:	2101 EXECUTIVE PARK DR STE 102
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6198
Country	:	US
Telephone Number	:	256-794-2593
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 EXECUTIVE PARK DR STE 102
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6198
Country	:	US
Telephone Number	:	256-794-2593
Fax Number	:	256-794-2593

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	DONNA JACKSON
Credential	:	LICSW
Telephone Number	:	256-794-2593

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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