Provider Demographics
NPI:1427522606
Name:6 C'S TO SUCCESS LLC
Entity type:Organization
Organization Name:6 C'S TO SUCCESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-738-1482
Mailing Address - Street 1:711 BRACEY PL
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:VA
Mailing Address - Zip Code:23950-2613
Mailing Address - Country:US
Mailing Address - Phone:434-738-1482
Mailing Address - Fax:888-722-4701
Practice Address - Street 1:711 BRACEY PL
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-2613
Practice Address - Country:US
Practice Address - Phone:434-738-1482
Practice Address - Fax:888-722-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14007323OtherCAQH
VA2019022734Medicaid
VA0701008125OtherLICENSE PROFESSIONAL COUNSELOR