Healthcare Provider Details

I. General information

NPI: 1194820118
Provider Name (Legal Business Name): INTENSIVE TRAUMA THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SCOTT AVENUE
MORGANTOWN WV
26508
US

IV. Provider business mailing address

314 SCOTT AVENUE
MORGANTOWN WV
26508
US

V. Phone/Fax

Practice location:
  • Phone: 304-291-2912
  • Fax: 304-291-2918
Mailing address:
  • Phone: 304-291-2912
  • Fax: 304-291-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPC001898
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00939059
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00942623
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number79001
License Number State

VIII. Authorized Official

Name: DR. LINDA GANTT
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD ATRBC
Phone: 304-291-2912