Provider Demographics
NPI:1902649452
Name:GULF COAST COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:GULF COAST COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:251-490-3927
Mailing Address - Street 1:14325A WARD RD
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-4001
Mailing Address - Country:US
Mailing Address - Phone:251-490-3927
Mailing Address - Fax:
Practice Address - Street 1:14251 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-4103
Practice Address - Country:US
Practice Address - Phone:251-490-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty