Provider Demographics
NPI:1326724782
Name:WILLOW GROVE COUNSELING, LCSW, PLLC
Entity Type:Organization
Organization Name:WILLOW GROVE COUNSELING, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, EDM
Authorized Official - Phone:716-225-4789
Mailing Address - Street 1:166 JEWETT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2336
Mailing Address - Country:US
Mailing Address - Phone:716-225-4789
Mailing Address - Fax:
Practice Address - Street 1:1965 SHERIDAN DR FL 2
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1251
Practice Address - Country:US
Practice Address - Phone:716-225-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty