Healthcare Provider Details

I. General information

NPI: 1508694589
Provider Name (Legal Business Name): MS. JULIA LYNN RAHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S EISENHOWER DR
BECKLEY WV
25801-4929
US

IV. Provider business mailing address

PO BOX 553
MIDWAY WV
25878-0553
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-7100
  • Fax:
Mailing address:
  • Phone: 681-368-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00947708
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: