Provider Demographics
NPI:1649657248
Name:AGAPE COUNSELING CENTER AND NETWORK
Entity type:Organization
Organization Name:AGAPE COUNSELING CENTER AND NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:707-384-7303
Mailing Address - Street 1:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0243
Mailing Address - Country:US
Mailing Address - Phone:707-384-7303
Mailing Address - Fax:707-247-4233
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:BLDG 2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-384-7303
Practice Address - Fax:707-247-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health