Organization
WESTERN CLINTON COUNTY COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINA-AYESHA A BLAIR MSW, LSW (DIRECTOR)
(570) 923-2904
Entity
Organization
Contact information
Practice address
425 SAINT CLAIR AVE, RENOVO, PA 17764-1068
(570) 923-2904
Mailing address
425 SAINT CLAIR AVE, PO BOX 462, RENOVO, PA 17764-1068
(570) 923-2904
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/07/2007
Last updated
08/22/2020
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