Healthcare Provider Details

I. General information

NPI: 1437074341
Provider Name (Legal Business Name): REBECCA HARRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 5TH AVE STE 194
CHARLESTON WV
25387-1900
US

IV. Provider business mailing address

501 STOCKTON ST
CHARLESTON WV
25387-2429
US

V. Phone/Fax

Practice location:
  • Phone: 304-408-3253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number26-987
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: