Healthcare Provider Details

I. General information

NPI: 1033836762
Provider Name (Legal Business Name): CHRISTIAN COUNSELING MINISTRIES OF WESTERN NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 MAIN ST
CLARENCE NY
14031-1825
US

IV. Provider business mailing address

9070 MAIN ST
CLARENCE NY
14031-1825
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-3200
  • Fax:
Mailing address:
  • Phone: 716-632-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YVONNE B BANKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-632-3200