Healthcare Provider Details

I. General information

NPI: 1396511234
Provider Name (Legal Business Name): DUSTIN L CONTOS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LOGAN ST
WILLIAMSON WV
25661-3606
US

IV. Provider business mailing address

PO BOX 2080
WILLIAMSON WV
25661-2080
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 304-235-8559
Mailing address:
  • Phone: 304-236-5902
  • Fax: 304-235-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2919
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: