Provider Demographics
NPI:1619713682
Name:HOUNDSTOOTH COUNSELING LLC
Entity type:Organization
Organization Name:HOUNDSTOOTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ANCIL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-394-3765
Mailing Address - Street 1:212 W TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4455
Mailing Address - Country:US
Mailing Address - Phone:205-523-5855
Mailing Address - Fax:
Practice Address - Street 1:710 RICHMOND PL
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1794
Practice Address - Country:US
Practice Address - Phone:205-394-3765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty