Provider Demographics
NPI:1427409226
Name:COUNSELING WELLNESS OF INDIANA COUNTY, LLC
Entity Type:Organization
Organization Name:COUNSELING WELLNESS OF INDIANA COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:724-717-6481
Mailing Address - Street 1:637 PHILADELPHIA ST
Mailing Address - Street 2:INDIANA THEATER BUILDING, SUITE 402
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3919
Mailing Address - Country:US
Mailing Address - Phone:724-717-6481
Mailing Address - Fax:724-717-6484
Practice Address - Street 1:637 PHILADELPHIA ST
Practice Address - Street 2:INDIANA THEATER BUILDING, SUITE 402
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3919
Practice Address - Country:US
Practice Address - Phone:724-717-6481
Practice Address - Fax:724-717-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005869251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health