Provider Demographics
NPI:1215486170
Name:COMMUNITY COUNSELING AGENCY
Entity type:Organization
Organization Name:COMMUNITY COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:SELVAGE
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:225-806-0797
Mailing Address - Street 1:2996 TECUMSEH ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-7979
Mailing Address - Country:US
Mailing Address - Phone:225-806-0797
Mailing Address - Fax:225-358-7997
Practice Address - Street 1:2996 TECUMSEH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7979
Practice Address - Country:US
Practice Address - Phone:225-806-0797
Practice Address - Fax:225-358-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health