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General NPI Number Information
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NPI Number | 1194047548
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Entity Type | Individual
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Provider Name | PEGGY JO PROUDFOOT HARMAN LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 320 18TH ST. GULLICKSON HALL SUITE G01
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City | HUNTINGTON
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State | WV
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Zip | 25703
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Country | US
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Telephone | 304-691-1643
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1392
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City | HUNTINGTON
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State | WV
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Zip | 25715-1392
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Country | US
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Telephone | 304-696-3751
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15530
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00945189
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License Number State | WV
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