Provider Demographics
NPI:1871891168
Name:AXIOM FAMILY COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:AXIOM FAMILY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VISNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:866-472-9466
Mailing Address - Street 1:225 W PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1313
Mailing Address - Country:US
Mailing Address - Phone:866-472-9466
Mailing Address - Fax:
Practice Address - Street 1:630 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-439-0308
Practice Address - Fax:724-439-0378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIOM FAMILY COUNSELING SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA433860251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA433860Medicaid
PA267015OtherPA DEPT OF HEALTH