Provider Demographics
NPI:1467919605
Name:COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
Entity Type:Organization
Organization Name:COUNSELING CENTER OF WAYNE & HOLMES COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DERUE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LSW
Authorized Official - Phone:330-264-9029
Mailing Address - Street 1:2285 BENDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2568
Mailing Address - Country:US
Mailing Address - Phone:330-264-9029
Mailing Address - Fax:
Practice Address - Street 1:2285 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2568
Practice Address - Country:US
Practice Address - Phone:330-264-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOURCEONE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health