Provider Demographics
NPI:1861279812
Name:AUTHENTIC HEALING COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:AUTHENTIC HEALING COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-347-1603
Mailing Address - Street 1:19 8TH STREET SOUTH
Mailing Address - Street 2:PMB 535
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1804
Mailing Address - Country:US
Mailing Address - Phone:701-347-1603
Mailing Address - Fax:
Practice Address - Street 1:1203 27TH AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8559
Practice Address - Country:US
Practice Address - Phone:701-347-1603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty