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General NPI Number Information
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NPI Number | 1093831844
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS COUNSELING SERVICE LLC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3501 EMERSON AVE SUITE 2 B
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City | PARKERSBURG
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State | WV
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Zip | 26104-1849
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Country | US
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Telephone | 304-420-0940
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Fax | 304-865-2214
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Provider Business Mailing Address
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Address Line | 3501 EMERSON AVE SUITE 2 B
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City | PARKERSBURG
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State | WV
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Zip | 26104-1849
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Country | US
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Telephone | 304-420-0940
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Fax | 304-865-2214
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. MICHAEL A KODRICH
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Credential | MA, LPC
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Telephone | 304-420-0940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1197
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License Number State | WV
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