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General NPI Number Information
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NPI Number | 1952889305
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Entity Type | Organization
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Legal Business Name | FIT MIND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 1017 6TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2348
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Country | US
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Telephone | 681-378-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 6TH AVE STE 11
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City | HUNTINGTON
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State | WV
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Zip | 25701-2348
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Country | US
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Telephone | 681-378-2134
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | JENNIFER A REGAN
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Credential | LICSW
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Telephone | 681-378-2134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | DP00945023
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License Number State | WV
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