Provider Demographics
NPI:1962554618
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:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-269-3923
Mailing Address - Street 1:5 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2177
Mailing Address - Country:US
Mailing Address - Phone:304-269-3923
Mailing Address - Fax:304-269-9733
Practice Address - Street 1:5 BROWN AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2177
Practice Address - Country:US
Practice Address - Phone:304-269-3923
Practice Address - Fax:304-269-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV454101YP2500X
WV687103TC0700X
WV934103TC0700X
WVAP00941728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007153Medicaid
WVFA9328331Medicare ID - Type Unspecified