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General NPI Number Information
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NPI Number | 1730955873
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Entity Type | Organization
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Legal Business Name | GRACE COMMUNITY CHURCH OF CRANBERRY TOWNSHIP PA
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 9160 MARSHALL RD
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-2912
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Country | US
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Telephone | 724-779-7997
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Fax | 724-779-7996
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Provider Business Mailing Address
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Address Line | 9160 MARSHALL RD
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-2912
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Country | US
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Telephone | 724-779-7997
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Fax | 724-779-7996
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMEY A FLEMING
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Credential |
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Telephone | 724-779-7997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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