Healthcare Provider Details

I. General information

NPI: 1215716931
Provider Name (Legal Business Name): LADOSKA SHEREE YEAGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 7TH AVE
HUNTINGTON WV
25701
US

IV. Provider business mailing address

1312 7TH AVE
HUNTINGTON WV
25701-2904
US

V. Phone/Fax

Practice location:
  • Phone: 681-378-6408
  • Fax: 681-888-5810
Mailing address:
  • Phone: 681-378-6408
  • Fax: 681-888-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1456
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: