Provider Demographics
NPI:1144463563
Name:CHRISTIAN COUNSELING OF COLUMBIA PA
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING OF COLUMBIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-692-3736
Mailing Address - Street 1:8555 STATION VILLAGE LN
Mailing Address - Street 2:#3139
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6543
Mailing Address - Country:US
Mailing Address - Phone:619-692-3736
Mailing Address - Fax:
Practice Address - Street 1:8555 STATION VILLAGE LN
Practice Address - Street 2:#3139
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6543
Practice Address - Country:US
Practice Address - Phone:619-692-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22538103G00000X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty