Provider Demographics
NPI:1740659697
Name:DIANA MASSO DBA COUNSELING ADVANTAGE
Entity type:Organization
Organization Name:DIANA MASSO DBA COUNSELING ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-541-9820
Mailing Address - Street 1:3102 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1214
Mailing Address - Country:US
Mailing Address - Phone:304-541-9820
Mailing Address - Fax:855-815-7553
Practice Address - Street 1:3102 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1214
Practice Address - Country:US
Practice Address - Phone:304-541-9820
Practice Address - Fax:855-815-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health