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2600 Middletown Cmns Ste 130 Fairmont WV 26554-0168 | |
| (303) 588-8296 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2600 Middletown Cmns Ste 130, Fairmont, West Virginia |
| Authorized Official Name and Position | Marion Bean Moreland (DIRECTOR) |
| Authorized Official Contact | 3035888296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2600 Middletown Cmns Ste 130 Fairmont WV 26554-0168 Ph: (303) 588-8296 | 2600 Middletown Cmns Ste 130 Fairmont WV 26554-0168 Ph: (303) 588-8296 |
| NPI Number | 1568172385 |
|---|---|
| Provider Enumeration Date | 12/02/2022 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568172385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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