Healthcare Provider Details

I. General information

NPI: 1336075829
Provider Name (Legal Business Name): WRG PA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 4TH AVE STE 1402
PITTSBURGH PA
15222-1715
US

IV. Provider business mailing address

1457 CENTRAL PARKWAY AVE SE
WARREN OH
44484-4458
US

V. Phone/Fax

Practice location:
  • Phone: 330-271-8486
  • Fax:
Mailing address:
  • Phone: 330-271-8486
  • Fax: 330-662-6601

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DANDRE BOWERS
Title or Position: CEO
Credential:
Phone: 330-271-8486