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General NPI Number Information
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NPI Number | 1053962241
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Entity Type | Organization
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Legal Business Name | MOUNTAIN CARE NETWORK
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 1021 QUARRIER ST STE 310
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City | CHARLESTON
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State | WV
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Zip | 25301-2338
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Country | US
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Telephone | 304-419-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 QUARRIER ST STE 310
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City | CHARLESTON
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State | WV
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Zip | 25301-2338
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Country | US
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Telephone | 304-419-8890
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL PRICE
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Credential | MSW, LICSW
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Telephone | 304-419-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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