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General NPI Number Information
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NPI Number | 1083103212
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Entity Type | Individual
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Provider Name | DARICE RENEE YERKOVICH LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 105 N WEDGE ST
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City | BRIDGEPORT
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State | WV
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Zip | 26330-2022
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Country | US
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Telephone | 304-598-0344
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Fax |
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Provider Business Mailing Address
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Address Line | 235 HIGH ST STE 322
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City | MORGANTOWN
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State | WV
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Zip | 26505-5455
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Country | US
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Telephone | 681-214-0025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | BP00945134
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BP00945134
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00945134
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | BP00945134
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BP00945134
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License Number State | WV
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