Healthcare Provider Details

I. General information

NPI: 1871188276
Provider Name (Legal Business Name): ANTHONY ARTHUR MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 KANAWHA BLVD E
CHARLESTON WV
25311-2413
US

IV. Provider business mailing address

1520 KANAWHA BLVD E
CHARLESTON WV
25311-2413
US

V. Phone/Fax

Practice location:
  • Phone: 681-265-9047
  • Fax: 681-265-9208
Mailing address:
  • Phone: 681-265-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2571
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2571
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: