1780650416 NPI number — AMITY L BOBLITS LICSW

Table of content: AMITY L BOBLITS LICSW (NPI 1780650416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780650416 NPI number — AMITY L BOBLITS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOBLITS
Provider First Name:
AMITY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780650416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 MALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK HILL
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25901-6216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-469-2905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 W OYLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK HILL
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25901-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-469-6331
Provider Business Practice Location Address Fax Number:
304-469-6332
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  DP00940891 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810001090 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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