Provider Demographics
NPI:1336215268
Name:STILLWATER CHRISTIAN COUNSELING PLLC
Entity type:Organization
Organization Name:STILLWATER CHRISTIAN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER SOLE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LUDWIG
Authorized Official - Last Name:KASPROWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-329-1900
Mailing Address - Street 1:130 S PRICE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1462
Mailing Address - Country:US
Mailing Address - Phone:304-329-1900
Mailing Address - Fax:304-329-1050
Practice Address - Street 1:130 S PRICE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1462
Practice Address - Country:US
Practice Address - Phone:304-329-1900
Practice Address - Fax:304-329-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164483000Medicaid
WVST9337991Medicare PIN