Healthcare Provider Details

I. General information

NPI: 1790432797
Provider Name (Legal Business Name): ASHLEY N. CAVENDER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LANCE DR
CHARLESTON WV
25311-1232
US

IV. Provider business mailing address

PO BOX 18116
SOUTH CHARLESTON WV
25303-8116
US

V. Phone/Fax

Practice location:
  • Phone: 304-546-2740
  • Fax:
Mailing address:
  • Phone: 304-546-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CAVENDER
Title or Position: LICENSED PSYCHOLOGIST
Credential: M.A.
Phone: 304-546-2740