Healthcare Provider Details

I. General information

NPI: 1902202732
Provider Name (Legal Business Name): COUNSELING AND WELLNESS CENTER OF PITTSBURGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 12/01/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WESTERN AVE
PITTSBURGH PA
15233-1772
US

IV. Provider business mailing address

830 WESTERN AVE
PITTSBURGH PA
15233-1772
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-2129
  • Fax:
Mailing address:
  • Phone: 412-322-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007895
License Number StatePA

VIII. Authorized Official

Name: STEPHANIE WIJKSTROM
Title or Position: THERAPIST
Credential: MA, LPC, NCC
Phone: 412-316-7397