Provider Demographics
NPI:1942528336
Name:PROFESSIONAL COUNSELING & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:BRAGG
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSW
Authorized Official - Phone:304-528-5815
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-1236
Mailing Address - Country:US
Mailing Address - Phone:304-942-0000
Mailing Address - Fax:304-522-0018
Practice Address - Street 1:4600A RT. 152
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-1236
Practice Address - Country:US
Practice Address - Phone:304-942-0000
Practice Address - Fax:304-522-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1728251S00000X
WVAP00940567251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health