Healthcare Provider Details

I. General information

NPI: 1588524417
Provider Name (Legal Business Name): GRANT LINDLEY MARPLE AADC-S, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 20TH ST
HUNTINGTON WV
25703-1850
US

IV. Provider business mailing address

800 20TH ST
HUNTINGTON WV
25703-1850
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax: 304-696-8701
Mailing address:
  • Phone: 304-696-8700
  • Fax: 304-696-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number96301
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: