Provider Demographics
NPI:1154464691
Name:TRANSITIONS INTERFAITH COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:TRANSITIONS INTERFAITH COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:CULBERTSON
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MDIV
Authorized Official - Phone:304-654-4213
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-0643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 MAIN ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1406
Practice Address - Country:US
Practice Address - Phone:304-654-4213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01837398OtherMOUNTAIN STATE BLUE CROSS