MEDICARE: MISS NANCY ALLENE CAPPS MA, CAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1184840654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NANCY ALLENE CAPPS MA, CAC

Provider Business Mailing Address
First Line	:	5050 SAINT PATRICK CIR
Second Line	:
City	:	CROSS LANES
State	:	WV
Zip	:	25313-3502
Country	:	US
Telephone Number	:	304-344-5924
Fax Number	:	304-344-3503

Provider Business Practice Location Address
First Line	:	2157 GREENBRIER ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9623
Country	:	US
Telephone Number	:	304-344-5924
Fax Number	:	304-344-3503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/21/2008

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