Healthcare Provider Details

I. General information

NPI: 1639962996
Provider Name (Legal Business Name): KATLIN GRACE CHRISTIAN WEBB
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 PERRY DR
FORT GAY WV
25514-7396
US

IV. Provider business mailing address

56 PERRY DR
FORT GAY WV
25514-7396
US

V. Phone/Fax

Practice location:
  • Phone: 606-615-1045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3142
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: