Healthcare Provider Details

I. General information

NPI: 1093314825
Provider Name (Legal Business Name): PASSAGES THERAPY AND COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEESE ST
ELKINS WV
26241-3758
US

IV. Provider business mailing address

PO BOX 290
HARMAN WV
26270-0290
US

V. Phone/Fax

Practice location:
  • Phone: 304-704-3885
  • Fax:
Mailing address:
  • Phone: 304-704-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLENA CHESTNUT
Title or Position: OWNER/ PSYCHOTHERAPIST
Credential: LICSW
Phone: 304-704-3885