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General NPI Number Information
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NPI Number | 1427627892
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Entity Type | Organization
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Legal Business Name | CLEAR CONNECTIONS COUNSELING LLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 714 VENTURE DR # 122
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City | MORGANTOWN
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State | WV
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Zip | 26508-7306
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Country | US
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Telephone | 304-504-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 714 VENTURE DR # 122
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City | MORGANTOWN
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State | WV
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Zip | 26508-7306
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Country | US
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Telephone | 304-504-4030
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | KRISTIN NICOLE JOHNSON-GIBEAUT
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Credential | NCC, LPC, CTT
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Telephone | 304-610-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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