Healthcare Provider Details

I. General information

NPI: 1568461218
Provider Name (Legal Business Name): ROBERT CUTHBERT LPC, CAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 TAVERN RD
MARTINSBURG WV
25401-2890
US

IV. Provider business mailing address

99 TAVERN RD
MARTINSBURG WV
25401-2890
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-7023
  • Fax: 304-264-0508
Mailing address:
  • Phone: 304-263-7023
  • Fax: 304-264-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1814
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: