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General NPI Number Information
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NPI Number | 1902059306
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Entity Type | Organization
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Legal Business Name | WOODSIDE PROFESSIONAL COUNSELING
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 314 6TH ST
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City | ELLWOOD CITY
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State | PA
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Zip | 16117-1907
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Country | US
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Telephone | 724-752-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 314 6TH ST
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City | ELLWOOD CITY
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State | PA
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Zip | 16117-1907
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Country | US
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Telephone | 724-752-0116
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARCY PEARSALL
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Credential | PHD
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Telephone | 724-752-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW013153
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License Number State | PA
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