Organization
THE COMMUNITY COUNSELING & HOUSING SERVICES
Active
Other names
THE PETROVA HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN SHELTON ED.S, ED.D, RADC-P (CEO)
(314) 580-3029
Entity
Organization
Contact information
Practice address
2407 PETROVA AVE, JENNINGS, MO 63136-3903
(314) 580-3029
Mailing address
4166 LINDELL BLVD APT 1B, SAINT LOUIS, MO 63108-2923
(314) 580-3029
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QV0200X
VA Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Enumeration date
02/08/2018
Last updated
02/08/2018
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