Healthcare Provider Details

I. General information

NPI: 1548836653
Provider Name (Legal Business Name): PEACE VALLEY COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 2ND AVE
SOUTH CHARLESTON WV
25303-1310
US

IV. Provider business mailing address

527 2ND AVE
SOUTH CHARLESTON WV
25303-1310
US

V. Phone/Fax

Practice location:
  • Phone: 681-341-2993
  • Fax:
Mailing address:
  • Phone: 681-341-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE MARIE HENSLEY
Title or Position: LPC/OWNER
Credential: LPC
Phone: 681-313-7674