Healthcare Provider Details

I. General information

NPI: 1811289333
Provider Name (Legal Business Name): AURORA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W 4TH AVE
RANSON WV
25438-1024
US

IV. Provider business mailing address

304 W 4TH AVE
RANSON WV
25438-1024
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-3461
  • Fax:
Mailing address:
  • Phone: 304-725-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number982
License Number StateWV

VIII. Authorized Official

Name: BONNIE LEE BRYANT
Title or Position: OWNER
Credential: PH.D.
Phone: 304-725-3461