# INTERCESSORY COUNSELING AND CONSULTING OUTREACH INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508473141
- **Authorized official:** DERRICK GIBSON (PROVIDER)
- **Authorized official phone:** (304) 415-5715

## Contact information

- **Practice address:** 1113B JEFFERSON RD, S CHARLESTON, WV 25309-9780
- **Practice address phone:** (304) 415-5715
- **Mailing address:** 1113B JEFFERSON RD, S CHARLESTON, WV 25309-9780
- **Mailing address phone:** (304) 415-5715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | Yes |
| 101YP2500X | Professional Counselor | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2020
- **Last updated:** 09/28/2020