Healthcare Provider Details

I. General information

NPI: 1003365628
Provider Name (Legal Business Name): SOCIAL WORK CONSULTING AND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BRADDOCK AVE
BRADDOCK PA
15104-1717
US

IV. Provider business mailing address

1007 PREMIER ST
PITTSBURGH PA
15201-2154
US

V. Phone/Fax

Practice location:
  • Phone: 412-204-6934
  • Fax:
Mailing address:
  • Phone: 412-204-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCW018857
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCW018857
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSOCIAL WORK STATE BOARDS

VIII. Authorized Official

Name: JESSICA LYNN GURLEY
Title or Position: OWNER / THERAPIST
Credential: LCSW
Phone: 412-204-6934