Provider Demographics
NPI:1841593365
Name:WINCHESTER COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WINCHESTER COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:540-535-1112
Mailing Address - Street 1:36 RICKETTS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3676
Mailing Address - Country:US
Mailing Address - Phone:540-535-1112
Mailing Address - Fax:540-535-1155
Practice Address - Street 1:121 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:540-535-1112
Practice Address - Fax:540-535-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1864101YP2500X
251B00000X, 251S00000X, 253Z00000X, 261QC1500X, 261QM0850X, 261QM0855X
WV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health