Provider Demographics
NPI:1114372026
Name:MAINSTREAMCOUNSELING
Entity Type:Organization
Organization Name:MAINSTREAMCOUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNERWOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-643-1114
Mailing Address - Street 1:900 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1826
Mailing Address - Country:US
Mailing Address - Phone:814-643-1114
Mailing Address - Fax:814-643-5344
Practice Address - Street 1:900 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1826
Practice Address - Country:US
Practice Address - Phone:814-643-1114
Practice Address - Fax:814-643-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA317013101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty