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General NPI Number Information
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NPI Number | 1013459627
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Entity Type | Organization
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Legal Business Name | SYNERGY INTEGRATIVE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 379 DEAN DR
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City | FAIRMONT
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State | WV
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Zip | 26554-8858
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Country | US
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Telephone | 304-366-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 379 DEAN DR
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City | FAIRMONT
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State | WV
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Zip | 26554-8858
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Country | US
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Telephone | 304-366-7288
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | DR. MICHAEL CHARLES RICHARDS
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Credential | LGSW
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Telephone | 304-366-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BP00944922
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License Number State | WV
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