Healthcare Provider Details

I. General information

NPI: 1346079944
Provider Name (Legal Business Name): TAYLOR MARIE HOVERMALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 HEDGESVILLE RD # SECTIONK
HEDGESVILLE WV
25427-6704
US

IV. Provider business mailing address

3790 HEDGESVILLE RD
HEDGESVILLE WV
25427-6704
US

V. Phone/Fax

Practice location:
  • Phone: 681-258-2382
  • Fax:
Mailing address:
  • Phone: 681-258-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1062
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: