Healthcare Provider Details

I. General information

NPI: 1659664258
Provider Name (Legal Business Name): COUNSELING AND TRAUMA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FOUR COINS DR
CANONSBURG PA
15317-1769
US

IV. Provider business mailing address

40 ROBIN DR
HICKORY PA
15340-1501
US

V. Phone/Fax

Practice location:
  • Phone: 724-579-3771
  • Fax: 724-356-2787
Mailing address:
  • Phone: 725-263-8883
  • Fax: 724-356-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005009
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN258900L
License Number StatePA

VIII. Authorized Official

Name: PAULINE AMAISMEIER
Title or Position: OWNER
Credential: LPC, NCC, RN-BC, DCC
Phone: 724-263-8883