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NPI Code Detail

MEDICARE: AGAPE COUNSELING CENTER LLC

MEDICARE: AGAPE COUNSELING CENTER 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
1101YM0800XMental Health Counselor
2103TC0700XClinical Psychologist
31041C0700XClinical Social Worker
4261QM0850XAdult Mental Health Clinic/Center
5261QM0855XAdolescent and Children Mental Health Clinic/Center
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1386272151
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGAPE COUNSELING CENTER LLC
Provider Business Mailing Address
First Line : 175 S MAIN ST
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458-2372
Country : US
Telephone Number : 937-434-0540
Fax Number : 937-434-6726
Provider Business Practice Location Address
First Line : 175 S MAIN ST
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458-2372
Country : US
Telephone Number : 937-434-0540
Fax Number : 937-434-6726
Authorized Official
Title or Position : CLINICAL SOCIAL WORKER/OWNER
Name : SARAH SUE PLASSMAN
Credential : MSW, LISW-S
Telephone Number : 937-416-4208
Provider Enumeration Date : 03/29/2020
Last Update Date : 03/29/2020

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