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NPI Code Detail

MEDICARE: DOUGLAS GRAHAM MCCARTY MS, LSW, CCAC

MEDICARE: DOUGLAS GRAHAM MCCARTY MS, LSW, CCAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorAP00942033WV

General Provider Information

NPI Number : 1619034402
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS GRAHAM MCCARTY MS, LSW, CCAC
Provider Business Mailing Address
First Line : 301 SCOTT AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-8804
Country : US
Telephone Number : 304-296-1731
Fax Number : 304-225-2288
Provider Business Practice Location Address
First Line : 301 SCOTT AVE
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-8804
Country : US
Telephone Number : 304-296-1731
Fax Number : 304-225-2288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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