Provider Demographics
NPI:1174797146
Name:DW COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:DW COUNSELING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LISAC
Authorized Official - Phone:480-461-0795
Mailing Address - Street 1:925 N STAPLEY DR
Mailing Address - Street 2:#A
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5637
Mailing Address - Country:US
Mailing Address - Phone:480-461-0795
Mailing Address - Fax:480-964-2323
Practice Address - Street 1:925 N STAPLEY DR
Practice Address - Street 2:#A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5637
Practice Address - Country:US
Practice Address - Phone:480-461-0795
Practice Address - Fax:480-964-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2258251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health