Healthcare Provider Details

I. General information

NPI: 1154268480
Provider Name (Legal Business Name): KELLY A MAYNOR MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 HENRY LOVING STREET
ANSTED WV
25812
US

IV. Provider business mailing address

PO BOX 759
ANSTED WV
25812-0759
US

V. Phone/Fax

Practice location:
  • Phone: 304-640-7788
  • Fax:
Mailing address:
  • Phone: 304-640-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCP00946051
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: