Healthcare Provider Details

I. General information

NPI: 1598466757
Provider Name (Legal Business Name): MOUNTAIN CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 QUARRIER ST
CHARLESTON WV
25301-1843
US

IV. Provider business mailing address

1206 QUARRIER ST
CHARLESTON WV
25301-1843
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3900
  • Fax: 304-988-4424
Mailing address:
  • Phone: 304-513-3900
  • Fax: 304-988-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAZMYN PRICE
Title or Position: BEHAVIORAL HEALTH PROVIDER
Credential: MSW
Phone: 304-729-4073