Provider Demographics
NPI:1275792251
Name:LWC COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:LWC COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN CS
Authorized Official - Phone:607-547-1130
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:101 103 MAIN STREET
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1286
Mailing Address - Country:US
Mailing Address - Phone:607-547-1130
Mailing Address - Fax:607-547-1130
Practice Address - Street 1:101 103 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1286
Practice Address - Country:US
Practice Address - Phone:607-547-1130
Practice Address - Fax:607-547-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291456364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0929Medicare PIN