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Organization
MAIN STREET COUNSELING CENTER, LLC
Active
Organization
MAIN STREET COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERI LEE GOLLY LCSW (OWNER)
(817) 886-5777
Entity
Organization
Contact information
Practice address
621 N MAIN ST, SUITE 200, GRAPEVINE, TX 76051-9213
(817) 886-5777
(817) 421-1950
Mailing address
621 N MAIN ST, SUITE 200, GRAPEVINE, TX 76051-9213
(817) 886-5777
(817) 421-1950
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16044
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063955102
—
TX
Enumeration date
04/23/2010
Last updated
04/23/2010
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