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General NPI Number Information
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NPI Number | 1841656832
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Entity Type | Organization
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Legal Business Name | BRANDYWINE VALLEY COUNSELING CENTER
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 999 W CHESTER PIKE SUITE B-1
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City | WEST CHESTER
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State | PA
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Zip | 19382-4877
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Country | US
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Telephone | 610-429-4100
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Fax | 610-429-1570
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Provider Business Mailing Address
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Address Line | 999 W CHESTER PIKE SUITE B-1
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City | WEST CHESTER
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State | PA
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Zip | 19382-4877
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Country | US
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Telephone | 610-429-4100
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Fax | 610-429-1570
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Authorized Official
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Title or Position | CEO
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Name | TODD L GRIMM
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Credential | MS, LPC
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Telephone | 610-429-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC000237
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License Number State | PA
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