Provider Demographics
NPI:1114654548
Name:POTOMAC HIGHLANDS MENTAL HEALTH GUILD, INC.
Entity Type:Organization
Organization Name:POTOMAC HIGHLANDS MENTAL HEALTH GUILD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1155
Mailing Address - Street 1:7 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1796
Mailing Address - Country:US
Mailing Address - Phone:304-257-1155
Mailing Address - Fax:304-257-1945
Practice Address - Street 1:7 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1796
Practice Address - Country:US
Practice Address - Phone:304-257-1155
Practice Address - Fax:304-257-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty