| Southway | |
|
4605 Maccorkle Ave Sw South Charleston WV 25309-1311 | |
| (304) 766-3536 | |
| (304) 414-2717 |
| Full Name | Southway |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4605 Maccorkle Ave Sw, South Charleston, West Virginia |
| Authorized Official Name and Position | Deonna Danielle Diamond (DIRECTOR OF PATIENT ACCOUNTS) |
| Authorized Official Contact | 3047663536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southway 4605 Maccorkle Ave Sw South Charleston WV 25309-1311 Ph: (304) 766-3536 | Southway 4605 Maccorkle Ave Sw South Charleston WV 25309-1311 Ph: (304) 766-3536 |
| NPI Number | 1801338850 |
|---|---|
| Provider Enumeration Date | 11/08/2016 |
| Last Update Date | 08/20/2024 |
| Certification Date | 08/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801338850 | NPI | - | NPPES |
| 0001391002 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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