Healthcare Provider Details

I. General information

NPI: 1952877334
Provider Name (Legal Business Name): CALLAHAN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 WILSON ST
MARTINSBURG WV
25402-1074
US

IV. Provider business mailing address

PO BOX 1074
MARTINSBURG WV
25402-1074
US

V. Phone/Fax

Practice location:
  • Phone: 304-579-4455
  • Fax: 304-596-8003
Mailing address:
  • Phone: 304-579-4455
  • Fax: 304-596-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER J CALLAHAN
Title or Position: OWNER
Credential: LICSW, ADC S, MAC,
Phone: 304-886-4118