Provider Demographics
NPI:1346734803
Name:PATRTNERSHIP OF AFRICAN AMERICAN CHURCHES
Entity Type:Organization
Organization Name:PATRTNERSHIP OF AFRICAN AMERICAN CHURCHES
Other - Org Name:PARTNERSHIP OF AFRICAN AMERICAN CHURCHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-768-7688
Mailing Address - Street 1:1514 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2533
Mailing Address - Country:US
Mailing Address - Phone:304-768-7688
Mailing Address - Fax:304-768-7647
Practice Address - Street 1:1514 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2533
Practice Address - Country:US
Practice Address - Phone:304-768-7688
Practice Address - Fax:304-768-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty