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General NPI Number Information
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NPI Number | 1467919605
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 2285 BENDEN DR
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City | WOOSTER
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State | OH
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Zip | 44691-2568
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Country | US
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Telephone | 330-264-9029
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 BENDEN DR
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City | WOOSTER
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State | OH
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Zip | 44691-2568
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Country | US
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Telephone | 330-264-9029
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DIANE SUSAN DERUE
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Credential | MPA, LSW
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Telephone | 330-264-9029
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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