Healthcare Provider Details

I. General information

NPI: 1225740160
Provider Name (Legal Business Name): MATTHEW DAVID INGLE LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 200
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

3375 US 60
HUNTINGTON WV
25705
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax:
Mailing address:
  • Phone: 304-525-7851
  • Fax: 304-525-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00945822
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00945822
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: