Healthcare Provider Details

I. General information

NPI: 1639623093
Provider Name (Legal Business Name): ELIZABETH CRUGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 CAMDEN AVE
PARKERSBURG WV
26101-5652
US

IV. Provider business mailing address

483 COURT ST
ELIZABETH WV
26143-1109
US

V. Phone/Fax

Practice location:
  • Phone: 304-917-3733
  • Fax: 304-917-3751
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008815
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: