Healthcare Provider Details

I. General information

NPI: 1417360348
Provider Name (Legal Business Name): GILLIAN KRAFFT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1876
US

IV. Provider business mailing address

1277 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1876
US

V. Phone/Fax

Practice location:
  • Phone: 304-381-2211
  • Fax: 304-206-3121
Mailing address:
  • Phone: 304-381-2211
  • Fax: 304-206-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00944802
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: