Healthcare Provider Details

I. General information

NPI: 1700714276
Provider Name (Legal Business Name): CASEY B VANDERBILT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ORCHARD ST
CHARLESTON WV
25302-2517
US

IV. Provider business mailing address

703 ORCHARD ST
CHARLESTON WV
25302-2517
US

V. Phone/Fax

Practice location:
  • Phone: 304-419-7759
  • Fax:
Mailing address:
  • Phone: 304-419-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: