Healthcare Provider Details

I. General information

NPI: 1740685700
Provider Name (Legal Business Name): NEWSOME COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2014
Last Update Date: 11/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 KANAWHA STATE FOREST DR
CHARLESTON WV
25314-9080
US

IV. Provider business mailing address

PO BOX 8880
SOUTH CHARLESTON WV
25303-0880
US

V. Phone/Fax

Practice location:
  • Phone: 304-415-2410
  • Fax: 855-314-6877
Mailing address:
  • Phone: 304-415-2410
  • Fax: 855-314-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1937
License Number StateWV

VIII. Authorized Official

Name: DR. JASON ERIC NEWSOME
Title or Position: OWNER
Credential: PHD
Phone: 304-415-2410