Provider Demographics
NPI:1992111660
Name:IMANI CHRISTIAN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:IMANI CHRISTIAN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMAINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-475-8428
Mailing Address - Street 1:5651 N PERSHING AVE
Mailing Address - Street 2:C-5
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4947
Mailing Address - Country:US
Mailing Address - Phone:209-475-8428
Mailing Address - Fax:209-475-8479
Practice Address - Street 1:5651 N PERSHING AVE
Practice Address - Street 2:C-5
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4947
Practice Address - Country:US
Practice Address - Phone:209-475-8428
Practice Address - Fax:209-475-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty