Provider Demographics
NPI:1447082656
Name:OVERCOMERS COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:OVERCOMERS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:TAMALA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DISNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:937-902-3220
Mailing Address - Street 1:2713 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4851
Mailing Address - Country:US
Mailing Address - Phone:937-902-3220
Mailing Address - Fax:
Practice Address - Street 1:30 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3804
Practice Address - Country:US
Practice Address - Phone:937-701-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health