Healthcare Provider Details

I. General information

NPI: 1023714110
Provider Name (Legal Business Name): PAYTON NICHOLE HANNAH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNBAR PLZ STE 100
DUNBAR WV
25064-3038
US

IV. Provider business mailing address

1021 QUARRIER ST STE 310
CHARLESTON WV
25301-2338
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3900
  • Fax:
Mailing address:
  • Phone: 304-513-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number519
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: