Provider Demographics
NPI:1801968987
Name:SOUTHSIDE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:SOUTHSIDE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:W
Authorized Official - Last Name:KRUMPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:757-255-2555
Mailing Address - Street 1:6072 GODWIN BLVD
Mailing Address - Street 2:PO BOX 2387
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1012
Mailing Address - Country:US
Mailing Address - Phone:757-255-2555
Mailing Address - Fax:757-255-7009
Practice Address - Street 1:6072 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23432-1012
Practice Address - Country:US
Practice Address - Phone:757-255-2555
Practice Address - Fax:757-255-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003187101YP2500X
VA0701002307101YP2500X
VA0701003999101YP2500X
VA0810001984103TC2200X
VA0717001033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty