Healthcare Provider Details

I. General information

NPI: 1215752951
Provider Name (Legal Business Name): CALLAHAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WINCHESTER AVE
MARTINSBURG WV
25401-1650
US

IV. Provider business mailing address

1020 WINCHESTER AVE
MARTINSBURG WV
25401-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-886-4118
  • Fax: 304-579-8606
Mailing address:
  • Phone: 304-886-4118
  • Fax:

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 TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAWN SANDLIN
Title or Position: BILLING
Credential:
Phone: 304-886-4118