Healthcare Provider Details

I. General information

NPI: 1073993234
Provider Name (Legal Business Name): KIMBERLY ERIN HOTLOSZ CRC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DONNA AVE
MORGANTOWN WV
26505-2884
US

IV. Provider business mailing address

1005 WHITE WILLOW WAY
MORGANTOWN WV
26505-6119
US

V. Phone/Fax

Practice location:
  • Phone: 304-319-1617
  • Fax:
Mailing address:
  • Phone: 304-460-5123
  • Fax: 800-734-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2076
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: