1912354523 NPI number — DAWN M NEELY MSW LICSW PLLC

Table of content: (NPI 1912354523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912354523 NPI number — DAWN M NEELY MSW LICSW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN M NEELY MSW LICSW PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912354523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
874 FAIRMONT RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26501-3893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-290-8138
Provider Business Mailing Address Fax Number:
304-598-0473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
874 FAIRMONT RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-290-8138
Provider Business Practice Location Address Fax Number:
304-598-0473
Provider Enumeration Date:
05/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEELY
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / SOLE MEMBER
Authorized Official Telephone Number:
304-290-8138

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  DP00941909 , 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)