Provider Demographics
NPI:1245737147
Name:INDIAN CREEK VALLEY CHRISTIAN FAMILY & CHILDREN'S CENTER
Entity Type:Organization
Organization Name:INDIAN CREEK VALLEY CHRISTIAN FAMILY & CHILDREN'S CENTER
Other - Org Name:CHRISTIAN COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:MERLE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:724-455-2122
Mailing Address - Street 1:2166 INDIAN HEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPION
Mailing Address - State:PA
Mailing Address - Zip Code:15622-3019
Mailing Address - Country:US
Mailing Address - Phone:724-455-2122
Mailing Address - Fax:724-455-6651
Practice Address - Street 1:2166 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:CHAMPION
Practice Address - State:PA
Practice Address - Zip Code:15622-3019
Practice Address - Country:US
Practice Address - Phone:724-455-2122
Practice Address - Fax:724-455-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010268101YP2500X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty