Provider Demographics
NPI:1285202457
Name:NEW VISION COUNSELING CENTER,LLC
Entity type:Organization
Organization Name:NEW VISION COUNSELING CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANDREA
Authorized Official - Middle Name:SHIRONE
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:334-398-0668
Mailing Address - Street 1:8436 CROSSLAND LOOP STE 106
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8522
Mailing Address - Country:US
Mailing Address - Phone:334-398-0668
Mailing Address - Fax:
Practice Address - Street 1:8436 CROSSLAND LOOP STE 106
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8522
Practice Address - Country:US
Practice Address - Phone:334-398-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1053931204Medicaid