1154464691 NPI number — TRANSITIONS INTERFAITH COUNSELING CENTER LLC

Table of content: (NPI 1154464691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154464691 NPI number — TRANSITIONS INTERFAITH COUNSELING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONS INTERFAITH COUNSELING CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1154464691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 643
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25545-0643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25504-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-654-4213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
CULBERTSON
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
304-654-4213

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1529 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01837398 . This is a "MOUNTAIN STATE BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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