Healthcare Provider Details

I. General information

NPI: 1760742993
Provider Name (Legal Business Name): PIKE COUNTY RECOVERY COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E EMMITT AVE
WAVERLY OH
45690-1337
US

IV. Provider business mailing address

PO BOX 226
WAVERLY OH
45690-0226
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-6727
  • Fax: 740-947-6917
Mailing address:
  • Phone: 740-947-6727
  • Fax: 740-947-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VERONICA MICHELLE BLACK
Title or Position: DEPUTY DIRECTOR
Credential: CDCA
Phone: 740-947-6727