Provider Demographics
NPI:1548816804
Name:CHAVIS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CHAVIS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-549-6967
Mailing Address - Street 1:600 INTERSTATE PARK DR STE 609
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5474
Mailing Address - Country:US
Mailing Address - Phone:334-549-6967
Mailing Address - Fax:334-676-3521
Practice Address - Street 1:600 INTERSTATE PARK DR STE 609
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5474
Practice Address - Country:US
Practice Address - Phone:334-549-6967
Practice Address - Fax:334-676-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty