Provider Demographics
NPI:1124433511
Name:FAMILY & MARITAL COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:FAMILY & MARITAL COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-622-5323
Mailing Address - Street 1:321 W MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2929
Mailing Address - Country:US
Mailing Address - Phone:304-622-5323
Mailing Address - Fax:304-622-5324
Practice Address - Street 1:321 W MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2929
Practice Address - Country:US
Practice Address - Phone:304-622-5323
Practice Address - Fax:304-622-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty