Healthcare Provider Details

I. General information

NPI: 1003872672
Provider Name (Legal Business Name): COMPREHENSIVE COUNSELING OF WASHINGTON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 E MAIDEN ST SUITE 31
WASHINGTON PA
15301-4964
US

IV. Provider business mailing address

87 E MAIDEN ST SUITE 31
WASHINGTON PA
15301-4964
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-3444
  • Fax: 724-222-2189
Mailing address:
  • Phone: 724-225-3444
  • Fax: 724-222-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M KANOTZ
Title or Position: GERERAL PARTNER
Credential: LCSW
Phone: 724-225-3444