Healthcare Provider Details

I. General information

NPI: 1205396272
Provider Name (Legal Business Name): E-COUNSELING WV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CLEVELAND AVE STE 210
FAIRMONT WV
26554-1663
US

IV. Provider business mailing address

309 CLEVELAND AVE STE 212
FAIRMONT WV
26554-1663
US

V. Phone/Fax

Practice location:
  • Phone: 681-214-8709
  • Fax:
Mailing address:
  • Phone: 681-214-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON BATTEN
Title or Position: MEMBER
Credential: LPC, AADC, CTT
Phone: 681-214-8709