Provider Demographics
NPI:1891477113
Name:IMMANUEL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:IMMANUEL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATRECE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:334-467-4992
Mailing Address - Street 1:888 WYNDHAM VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7494
Mailing Address - Country:US
Mailing Address - Phone:334-467-4992
Mailing Address - Fax:334-665-5666
Practice Address - Street 1:3104 S RAILROAD ST STE B
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2992
Practice Address - Country:US
Practice Address - Phone:334-655-1414
Practice Address - Fax:334-665-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty