Provider Demographics
NPI:1306536107
Name:COLLECTIVE COUNSELING CENTRE INC
Entity type:Organization
Organization Name:COLLECTIVE COUNSELING CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:800-940-5869
Mailing Address - Street 1:24920 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:N DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24920 RIVER RD
Practice Address - Street 2:
Practice Address - City:N DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8332
Practice Address - Country:US
Practice Address - Phone:800-940-5869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health