Provider Demographics
NPI:1083805055
Name:NEW MARTINSVILLE COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:NEW MARTINSVILLE COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW, LICSW
Authorized Official - Phone:304-455-6505
Mailing Address - Street 1:296 N STATE ROUTE 2 # 120
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2241
Mailing Address - Country:US
Mailing Address - Phone:304-455-6505
Mailing Address - Fax:
Practice Address - Street 1:525 THIRD ST.
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155
Practice Address - Country:US
Practice Address - Phone:304-455-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009391691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty