Healthcare Provider Details

I. General information

NPI: 1609671858
Provider Name (Legal Business Name): VIRGINIA GRACE DELAWDER M.ED., NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR
CLARKSBURG WV
26301-4155
US

IV. Provider business mailing address

1 MED CENTER DR
CLARKSBURG WV
26301-4155
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-6431
  • Fax:
Mailing address:
  • Phone: 304-623-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4040976
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: