Indian Creek Valley Christian Family & Children'S Center

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC010268 Issued in PA

Legal business name

INDIAN CREEK VALLEY CHRISTIAN FAMILY & CHILDREN'S CENTER

Practice address

2166 Indian Head Rd
Champion, PA 15622-3019

Phone

(724) 455-2122

Fax

(724) 455-6651

NPI assigned

Apr 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dwight Merle Skinner II, LPCNPI 1083122287

Title

Executive Director

Phone

(724) 455-2122

Specialties & licenses 2

Addresses

Other names 1

• Christian Counseling Services Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dwight Merle Skinner II

  • Professional Counselor
  • Champion, PA
  • NPI 1083122287
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1245737147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 INDIAN HEAD RD",
            "city": "CHAMPION",
            "state": "PA",
            "postal_code": "156223019",
            "telephone_number": "724-455-2122",
            "fax_number": "724-455-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 INDIAN HEAD RD",
            "city": "CHAMPION",
            "state": "PA",
            "postal_code": "156223019",
            "telephone_number": "724-455-2122",
            "fax_number": "724-455-6651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1076 Kings Way",
            "address_purpose": "LOCATION",
            "city": "Donegal",
            "state": "PA",
            "postal_code": "156284066",
            "country_code": "US",
            "telephone_number": "724-593-9200 x103",
            "fax_number": "724-593-9210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIAN CREEK VALLEY CHRISTIAN FAMILY & CHILDREN'S CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-09",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SKINNER",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "MERLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-455-2122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC010268",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Counseling Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Christian Counseling Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dwight Merle Skinner II

• Professional Counselor in Champion, PA
• Providers in Champion, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.