Healthcare Provider Details

I. General information

NPI: 1902430085
Provider Name (Legal Business Name): HOLLIE MCCLANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 KANAWHA BLVD E
CHARLESTON WV
25301-2403
US

IV. Provider business mailing address

1001 HIGHLAND RD
CHARLESTON WV
25302-3014
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-9689
  • Fax:
Mailing address:
  • Phone: 765-238-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3251
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: