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NPI Code Detail

MEDICARE: APPALACHIAN COUNSELING CENTER LLC

MEDICARE: APPALACHIAN COUNSELING CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TF0000XFamily Psychologist
2103TS0200XSchool Psychologist
3104100000XSocial Worker
41041C0700XClinical Social Worker
5101YM0800XMental Health Counselor
6101YP1600XPastoral Counselor
7101YP2500XProfessional Counselor
8103TC0700XClinical Psychologist
9103TC1900XCounseling Psychologist
10101Y00000XCounselor
11101YA0400XAddiction (Substance Use Disorder) Counselor
12103T00000XPsychologist

General Provider Information

NPI Number : 1568928877
Entity Type Code : Organization
Provider Name (Legal Business Name) : APPALACHIAN COUNSELING CENTER LLC
Provider Business Mailing Address
First Line : 207 FAIRMONT AVE
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-2710
Country : US
Telephone Number : 681-404-6869
Fax Number :
Provider Business Practice Location Address
First Line : 207 FAIRMONT AVE
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-2710
Country : US
Telephone Number : 681-404-6869
Fax Number : 681-404-6871
Authorized Official
Title or Position : PRESIDENT
Name : DR. JUDITH ANN BLACK
Credential : LPC, ALPS NCC, LCMHC
Telephone Number : 681-404-6869
Provider Enumeration Date : 02/12/2019
Last Update Date : 01/17/2024

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Directions to “APPALACHIAN COUNSELING CENTER LLC ” Practice Location

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