Provider Demographics
NPI:1679130488
Name:KDR COUNSELING & CONSULTING SERVICE
Entity type:Organization
Organization Name:KDR COUNSELING & CONSULTING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-915-2431
Mailing Address - Street 1:913 VILLAGE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-4331
Mailing Address - Country:US
Mailing Address - Phone:205-915-2431
Mailing Address - Fax:
Practice Address - Street 1:913 VILLAGE MILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-4331
Practice Address - Country:US
Practice Address - Phone:205-915-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health