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General NPI Number Information
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NPI Number | 1720143555
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 41 W 5TH AVE
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City | WILLIAMSON
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State | WV
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Zip | 25661-3201
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Country | US
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Telephone | 304-235-3390
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Fax | 304-235-3391
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Provider Business Mailing Address
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Address Line | 41 W 5TH AVE
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City | WILLIAMSON
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State | WV
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Zip | 25661-3201
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Country | US
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Telephone | 304-235-3390
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Fax | 304-235-3391
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | DR. SUSAN CAROL BAISDEN
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Credential | PHD
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Telephone | 304-235-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 538
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CP00452669
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 403
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License Number State | WV
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