Provider Demographics
NPI:1992059117
Name:AGAPE CHRISTIAN COUNSELING,LLC
Entity type:Organization
Organization Name:AGAPE CHRISTIAN COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-544-3517
Mailing Address - Street 1:500 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1018
Practice Address - Country:US
Practice Address - Phone:618-544-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490076471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty