MEDICARE: GENISE LYNN LALOS LSW, 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	95-302S	WV
2	1041C0700X	Clinical Social Worker	AP00940219	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP00940219	OTHER	WV	LSW
2	95-102S	OTHER	WV	CCS
3	95-302S	OTHER	WV	CCAC

General Provider Information

NPI Number	:	1437274263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENISE LYNN LALOS LSW, CAC

Provider Business Mailing Address
First Line	:	2 ROBIN LN
Second Line	:	SHERWOOD ESTATES
City	:	ONA
State	:	WV
Zip	:	25545-9749
Country	:	US
Telephone Number	:	304-736-6874
Fax Number	:	304-697-1286

Provider Business Practice Location Address
First Line	:	1420 WASHINGTON AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25704-1519
Country	:	US
Telephone Number	:	304-525-7851
Fax Number	:	304-697-1286

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/11/2025

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