Healthcare Provider Details

I. General information

NPI: 1619803350
Provider Name (Legal Business Name): MAIZY TALBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VERMILLION ST
ATHENS WV
24712-9027
US

IV. Provider business mailing address

1000 VERMILLION ST
ATHENS WV
24712-9027
US

V. Phone/Fax

Practice location:
  • Phone: 540-641-0126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: