Healthcare Provider Details

I. General information

NPI: 1740291897
Provider Name (Legal Business Name): HIGHLAND BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 MACCORKLE AVE SE SUITE 6
CHARLESTON WV
25304
US

IV. Provider business mailing address

PO BOX 4009
CHARLESTON WV
25364-4009
US

V. Phone/Fax

Practice location:
  • Phone: 304-926-1646
  • Fax: 304-926-1686
Mailing address:
  • Phone: 304-348-1288
  • Fax: 304-348-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1447
License Number StateWV

VIII. Authorized Official

Name: DAVID M MCWATTERS III
Title or Position: CEO
Credential:
Phone: 304-348-1288