Healthcare Provider Details

I. General information

NPI: 1487825410
Provider Name (Legal Business Name): THE FAMILY INSTITUTE OF WEST VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S OAKWOOD AVE
BECKLEY WV
25801-5928
US

IV. Provider business mailing address

23 FLAT TOP LAKE RD
GHENT WV
25843-9359
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-8068
  • Fax:
Mailing address:
  • Phone: 304-253-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. HEATHER ANNE HAGERMAN
Title or Position: DIRECTOR/OWNER
Credential: PH.D.
Phone: 304-253-8068