Healthcare Provider Details

I. General information

NPI: 1558505545
Provider Name (Legal Business Name): MELISSA DAWN CROWE-WEEKLEY LW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

IV. Provider business mailing address

6 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-5661
  • Fax: 304-623-2180
Mailing address:
  • Phone: 304-623-5661
  • Fax: 304-623-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00943169
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: