Healthcare Provider Details

I. General information

NPI: 1215666177
Provider Name (Legal Business Name): BWC AMPLIFIED COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 A BEAVER DRIVE
DUBOIS PA
15801
US

IV. Provider business mailing address

6221 ROUTE 474
ASHVILLE NY
14710-9788
US

V. Phone/Fax

Practice location:
  • Phone: 800-820-3101
  • Fax: 412-329-4239
Mailing address:
  • Phone: 716-456-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARISA TERRY
Title or Position: CADC OFFICIAL
Credential: CADC
Phone: 716-455-6122