Provider Demographics
NPI:1336424357
Name:GRASSROUTES COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GRASSROUTES COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:LANA
Authorized Official - Last Name:DREW-BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,LSW
Authorized Official - Phone:724-454-7136
Mailing Address - Street 1:206 DONORA RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15062
Mailing Address - Country:US
Mailing Address - Phone:724-454-7136
Mailing Address - Fax:
Practice Address - Street 1:719 SCHOONMAKER AVE
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062
Practice Address - Country:US
Practice Address - Phone:724-454-7136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty