Provider Demographics
NPI:1780274704
Name:ADAIAH BIBLICAL COUNSELING
Entity type:Organization
Organization Name:ADAIAH BIBLICAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MHSP
Authorized Official - Phone:615-853-1254
Mailing Address - Street 1:695 FOX TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6251
Mailing Address - Country:US
Mailing Address - Phone:615-853-1254
Mailing Address - Fax:
Practice Address - Street 1:695 FOX TRAIL CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6251
Practice Address - Country:US
Practice Address - Phone:615-853-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty