Healthcare Provider Details

I. General information

NPI: 1134641889
Provider Name (Legal Business Name): FRESH PERSPECTIVE PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 DOGTOWN RD
REEDSVILLE WV
26547-7056
US

IV. Provider business mailing address

2917 DOGTOWN RD
REEDSVILLE WV
26547-7056
US

V. Phone/Fax

Practice location:
  • Phone: 304-841-2259
  • Fax:
Mailing address:
  • Phone: 304-900-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00943676
License Number StateWV

VIII. Authorized Official

Name: MRS. SHEENA NICHOLSON
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: MSW, LICSW
Phone: 304-900-2002