Healthcare Provider Details
I. General information
NPI: 1174683395
Provider Name (Legal Business Name): ASSOCIATES IN COUNSELING AND CHILD GUIDANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/11/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
272 EAST CONNELLY BLVD.
SHARON PA
16146
US
IV. Provider business mailing address
272 EAST CONNELLY BLVD.
SHARON PA
16146
US
V. Phone/Fax
- Phone: 724-983-1131
- Fax: 724-983-1387
- Phone: 724-983-1131
- Fax: 724-983-1387
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 409240 |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 409240 |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC1900X |
| Taxonomy | Counseling Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 409240 |
| License Number State | PA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TR0400X |
| Taxonomy | Rehabilitation Psychologist |
| License Number | 409240 |
| License Number State | PA |
VIII. Authorized Official
Name: MR.
SHAYEN
GEORGE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A. IN PSYCHOLOGY
Phone: 724-983-1131
