Healthcare Provider Details

I. General information

NPI: 1447692520
Provider Name (Legal Business Name): FREDERICK MICHAEL HUFFORD M. A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 QUARRIER ST SUITE 410-411
CHARLESTON WV
25301-2613
US

IV. Provider business mailing address

4806 STAUNTON AVE .SE
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-2748
  • Fax:
Mailing address:
  • Phone: 304-925-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number57
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: