Healthcare Provider Details

I. General information

NPI: 1124826763
Provider Name (Legal Business Name): CARLA DAWN BARR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

IV. Provider business mailing address

PO BOX 442
CANVAS WV
26662-0442
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2659
  • Fax: 304-872-1685
Mailing address:
  • Phone: 304-619-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: