MEDICARE: CHRISTIAN COUNSELING PROFESSIONALS OF MOBILE, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1447972914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN COUNSELING PROFESSIONALS OF MOBILE, LLC

Provider Business Mailing Address
First Line	:	8825 DAWES LAKE RD N
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36619-4345
Country	:	US
Telephone Number	:	251-622-6838
Fax Number	:	251-650-1726

Provider Business Practice Location Address
First Line	:	7268 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-2825
Country	:	US
Telephone Number	:	251-308-6838
Fax Number	:	251-650-1726

Authorized Official
Title or Position	:	COUNSELOR
Name	:	TINA S HOWARD
Credential	:	LPC
Telephone Number	:	251-308-6838

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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