Provider Demographics
NPI:1972727048
Name:COMMUNITY COUNSELING CENTER OF MERCER COUNTY
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER OF MERCER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY OUTREACH AND DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:FERN
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LSW
Authorized Official - Phone:724-981-7141
Mailing Address - Street 1:2201 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2727
Mailing Address - Country:US
Mailing Address - Phone:724-981-7141
Mailing Address - Fax:724-981-7148
Practice Address - Street 1:107 BRECKENRIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1025
Practice Address - Country:US
Practice Address - Phone:724-458-4144
Practice Address - Fax:724-458-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402750261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000380 0038Medicaid
PA151487Medicare ID - Type UnspecifiedCCC'S #
PAW80465Medicare UPIN