Healthcare Provider Details

I. General information

NPI: 1972953552
Provider Name (Legal Business Name): JESSICA BELCHER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 QUARRIER ST SUITE 414
CHARLESTON WV
25301-2338
US

IV. Provider business mailing address

1021 QUARRIER ST SUITE 414
CHARLESTON WV
25301-2338
US

V. Phone/Fax

Practice location:
  • Phone: 304-340-3676
  • Fax: 304-340-3688
Mailing address:
  • Phone: 304-340-3676
  • Fax: 304-340-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2130
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: