Healthcare Provider Details

I. General information

NPI: 1609459189
Provider Name (Legal Business Name): MOUNTAIN CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1021 QUARRIER ST STE 310
CHARLESTON WV
25301-2338
US

IV. Provider business mailing address

1021 QUARRIER ST STE 310
CHARLESTON WV
25301-2338
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3900
  • Fax: 304-988-4424
Mailing address:
  • Phone: 304-513-3900
  • Fax: 304-988-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL PRICE
Title or Position: OWNER
Credential: MSW, LICSW
Phone: 304-419-8890