=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255485348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY COUNSELING AND CHILDREN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1392 E STATE ST
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16146-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-982-4240
-----------------------------------------------------
Fax | 724-982-4332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1392 E STATE ST
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16146-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-982-4240
-----------------------------------------------------
Fax | 724-982-4332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. MARY WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-982-4240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------