Provider Demographics
NPI:1326521840
Name:COMPASS COUNSELING, LLC
Entity Type:Organization
Organization Name:COMPASS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:304-254-8709
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:MABSCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:25871-0046
Mailing Address - Country:US
Mailing Address - Phone:304-731-0925
Mailing Address - Fax:
Practice Address - Street 1:345 PRINCE ST STE 1
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4515
Practice Address - Country:US
Practice Address - Phone:304-254-8709
Practice Address - Fax:304-254-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCP00941029OtherLCSW
WV480Medicaid