Provider Demographics
NPI:1720816747
Name:INTERCONNECTIONS COUNSELING AND CONSULTING
Entity type:Organization
Organization Name:INTERCONNECTIONS COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPS
Authorized Official - Phone:304-582-0516
Mailing Address - Street 1:3158 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3502
Mailing Address - Country:US
Mailing Address - Phone:304-582-0516
Mailing Address - Fax:
Practice Address - Street 1:108 S SAMUEL ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-582-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty