Healthcare Provider Details

I. General information

NPI: 1356455091
Provider Name (Legal Business Name): FAMILY SERVICE OF MARION & HARRISON COUNTIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LOCUST AVE SUITE 101
FAIRMONT WV
26554-1435
US

IV. Provider business mailing address

1313 LOCUST AVE SUITE 101
FAIRMONT WV
26554-1435
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-4750
  • Fax: 304-366-4753
Mailing address:
  • Phone: 304-366-4750
  • Fax: 304-366-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN JONES
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 304-366-4750