Provider Demographics
NPI:1053014423
Name:LAKE COUNSELING, LLC
Entity type:Organization
Organization Name:LAKE COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-695-5549
Mailing Address - Street 1:164 STATE DOCKS RD STE C
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-3110
Mailing Address - Country:US
Mailing Address - Phone:334-695-5549
Mailing Address - Fax:334-647-2034
Practice Address - Street 1:164 STATE DOCKS RD STE C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-3110
Practice Address - Country:US
Practice Address - Phone:334-695-5549
Practice Address - Fax:334-647-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty