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General NPI Number Information
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NPI Number | 1295271377
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Entity Type | Organization
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Legal Business Name | WILLOW BAY CHRISTIAN COUNSELING SERVICES
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 216 MYSTIC PINE TRL
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-4614
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Country | US
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Telephone | 412-360-9428
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Fax |
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Provider Business Mailing Address
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Address Line | 9909 BELTON CIR
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City | WEXFORD
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State | PA
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Zip | 15090-9686
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LPC
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Name | DONNA SPATIG
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Credential |
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Telephone | 412-360-9428
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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 | PC006118
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License Number State | PA
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