Healthcare Provider Details

I. General information

NPI: 1396487138
Provider Name (Legal Business Name): DOUGLAS CLAYTON STOVER ADC, CBCS, PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 STEWART PLZ
DUNBAR WV
25064-3021
US

IV. Provider business mailing address

8296 OHIO RIVER RD
LESAGE WV
25537-9793
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-2034
  • Fax:
Mailing address:
  • Phone: 681-378-3908
  • Fax: 304-759-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberP7L5E7P3
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: