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General NPI Number Information
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NPI Number | 1801831953
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Entity Type | Organization
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Legal Business Name | WEST COUNTY CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 2638 HIGHWAY 109
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City | WILDWOOD
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State | MO
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Zip | 63040-1161
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Country | US
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Telephone | 636-405-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 2638 HIGHWAY 109
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City | WILDWOOD
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State | MO
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Zip | 63040-1161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSANNA DIERINZO
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Credential |
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Telephone | 636-405-1352
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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 |
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License Number State |
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