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General NPI Number Information
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NPI Number | 1083428734
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Entity Type | Organization
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Legal Business Name | CRITTENTON SERVICES
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 761 3RD ST # 1403
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-1403
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Country | US
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Telephone | 304-455-3035
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Fax | 304-455-3035
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Provider Business Mailing Address
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Address Line | 761 3RD ST
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-1403
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Country | US
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Telephone | 304-455-3035
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Fax |
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Authorized Official
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Title or Position | COMMUNITY LIAISON
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Name | MS. BRANDY MICHELLE KOCHER
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Credential | RBA
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Telephone | 304-455-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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