| Jefferson Day Report Center, Inc. | |
|
130 E Burr Blvd Fl 1 Kearneysville WV 25430-4788 | |
| (304) 728-3527 | |
| (304) 728-3614 |
| Full Name | Jefferson Day Report Center, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 130 E Burr Blvd Fl 1, Kearneysville, West Virginia |
| Authorized Official Name and Position | Kelly Franklin (DIRECTOR) |
| Authorized Official Contact | 3047283257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Day Report Center, Inc. 130 E Burr Blvd Fl 1 Kearneysville WV 25430-4788 Ph: (304) 728-3527 | Jefferson Day Report Center, Inc. 130 E Burr Blvd Fl 1 Kearneysville WV 25430-4788 Ph: (304) 728-3527 |
| NPI Number | 1790130508 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 09/11/2024 |
| Certification Date | 09/11/2024 |
| Medicare PECOS PAC ID | 7517229966 |
|---|---|
| Medicare Enrollment ID | O20180322001288 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790130508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 521 (West Virginia) | Primary |
| 1041C0700X | Social Worker - Clinical | (West Virginia) | Secondary |
| Provider Name | Scott A Gilchrist |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255656468 PECOS PAC ID: 6800054065 Enrollment ID: I20120221000012 |
| Provider Name | Ryan Wakim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093033789 PECOS PAC ID: 3375702731 Enrollment ID: I20120306000019 |
| Provider Name | Peggy V Nave |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497914469 PECOS PAC ID: 6002193984 Enrollment ID: I20180326001536 |
| Provider Name | Gregory A George |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972139582 PECOS PAC ID: 6507308442 Enrollment ID: I20240607000217 |
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