Basic Information
| Provider Information | |||||||||
| NPI: | 1417548702 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABC COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 BOB WALLACE AVE SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568082522 | ||||||||
| FaxNumber: | 2568082523 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 BOB WALLACE AVE SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568082522 | ||||||||
| FaxNumber: | 2568082523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2021 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHAFFIN | ||||||||
| AuthorizedOfficialFirstName: | ALEISHA | ||||||||
| AuthorizedOfficialMiddleName: | BOODOIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2568082522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.