Healthcare Provider Details

I. General information

NPI: 1508137969
Provider Name (Legal Business Name): TWO RIVERS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E LIBERTY ST
CHARLES TOWN WV
25414-1824
US

IV. Provider business mailing address

224 E LIBERTY ST
CHARLES TOWN WV
25414-1824
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-7176
  • Fax:
Mailing address:
  • Phone: 304-725-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2010
License Number StateWV

VIII. Authorized Official

Name: MRS. ROBYN HARRISON-TAFT
Title or Position: OWNER
Credential: LPC
Phone: 304-579-3272