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General NPI Number Information
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NPI Number | 1598397630
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 1802 HARPER RD STE 200
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City | BECKLEY
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State | WV
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Zip | 25801-3376
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Country | US
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Telephone | 304-252-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 HARPER RD STE 200
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City | BECKLEY
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State | WV
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Zip | 25801-3376
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Country | US
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Telephone | 681-238-5733
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTY SPADE
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Credential |
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Telephone | 304-252-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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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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