Provider Demographics
NPI:1558811679
Name:NORTHERN PANHANDLE COMMUNITY CRIMINAL JUSTICE BOARD
Entity Type:Organization
Organization Name:NORTHERN PANHANDLE COMMUNITY CRIMINAL JUSTICE BOARD
Other - Org Name:LEE DAY REPORT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-234-6445
Mailing Address - Street 1:3828 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5312
Mailing Address - Country:US
Mailing Address - Phone:304-748-8043
Mailing Address - Fax:304-748-4175
Practice Address - Street 1:3828 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5312
Practice Address - Country:US
Practice Address - Phone:304-748-8043
Practice Address - Fax:304-748-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty