Provider Demographics
NPI:1669644852
Name:PETER J. CALLAHAN, PLLC
Entity Type:Organization
Organization Name:PETER J. CALLAHAN, PLLC
Other - Org Name:CALLAHAN, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CAC-S, CCFC
Authorized Official - Phone:304-886-4118
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1074
Mailing Address - Country:US
Mailing Address - Phone:304-886-4118
Mailing Address - Fax:304-579-8606
Practice Address - Street 1:1020 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1650
Practice Address - Country:US
Practice Address - Phone:304-886-4118
Practice Address - Fax:304-579-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009419421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty