Provider Demographics
NPI:1457750341
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 MARGARET AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3081
Mailing Address - Country:US
Mailing Address - Phone:724-205-6361
Mailing Address - Fax:800-398-6217
Practice Address - Street 1:225 MARGARET AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3081
Practice Address - Country:US
Practice Address - Phone:724-205-6361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA650054251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650054OtherDEPARTMENT OF HEALTH
PA433860Medicaid