Provider Demographics
NPI:1891239810
Name:AXIOM FAMILY COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:AXIOM FAMILY COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VISNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:866-472-9466
Mailing Address - Street 1:225 W PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1313
Mailing Address - Country:US
Mailing Address - Phone:866-472-9466
Mailing Address - Fax:800-398-6217
Practice Address - Street 1:100 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1539
Practice Address - Country:US
Practice Address - Phone:866-472-9466
Practice Address - Fax:800-398-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117061251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117061OtherPA DEPARTMENT OF HEALTH