Healthcare Provider Details

I. General information

NPI: 1356272546
Provider Name (Legal Business Name): MCDOWELL COUNTY DAY REPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WYOMING ST
WELCH WV
24801-2261
US

IV. Provider business mailing address

109 WYOMING ST
WELCH WV
24801-2261
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-9009
  • Fax: 304-436-4351
Mailing address:
  • Phone: 304-436-9009
  • Fax: 304-436-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: WENDY WHITE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 304-688-7027