| Appalachian Life Enrichment Counseling Center | |
|
207 Fairmont Ave Fairmont WV 26554-2710 | |
| (681) 404-6869 | |
| (681) 404-6871 |
| Full Name | Appalachian Life Enrichment Counseling Center |
|---|---|
| Speciality | Psychologist |
| Location | 207 Fairmont Ave, Fairmont, West Virginia |
| Authorized Official Name and Position | Judith Ann Black (PRESIDENT) |
| Authorized Official Contact | 6814046869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Appalachian Life Enrichment Counseling Center 207 Fairmont Ave Fairmont WV 26554-2710 Ph: (681) 404-6869 | Appalachian Life Enrichment Counseling Center 207 Fairmont Ave Fairmont WV 26554-2710 Ph: (681) 404-6869 |
| NPI Number | 1568928877 |
|---|---|
| Provider Enumeration Date | 02/12/2019 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Medicare PECOS PAC ID | 5597115782 |
|---|---|
| Medicare Enrollment ID | O20231229002926 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568928877 | NPI | - | NPPES |
| Provider Name | Yukiko Comstock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487179628 PECOS PAC ID: 7810340254 Enrollment ID: I20240201000977 |
| Provider Name | Sheli Bernstein-goff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972673986 PECOS PAC ID: 8022461482 Enrollment ID: I20240201001667 |
| Provider Name | Haley Wable |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093349797 PECOS PAC ID: 4385097674 Enrollment ID: I20240202002231 |
| Provider Name | Jennifer Nicole Morris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184236788 PECOS PAC ID: 2567805534 Enrollment ID: I20240206004369 |
| Provider Name | Jaimie Choi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467231860 PECOS PAC ID: 8022451905 Enrollment ID: I20240207003230 |
| Provider Name | Renee Marsh |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1245906288 PECOS PAC ID: 1254774193 Enrollment ID: I20240208000567 |
| Provider Name | Heather Thurbon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053952788 PECOS PAC ID: 9234572017 Enrollment ID: I20240208002349 |
| Provider Name | Kiley Rhae Brescoach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881241479 PECOS PAC ID: 8224471859 Enrollment ID: I20240209003098 |
| Provider Name | Danielle Larae Laratta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417627555 PECOS PAC ID: 2062855539 Enrollment ID: I20240212003404 |
| Provider Name | Mark Anthony King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982278073 PECOS PAC ID: 2668815036 Enrollment ID: I20240213002595 |
| Provider Name | Robert Clinton Funk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801358478 PECOS PAC ID: 5991149163 Enrollment ID: I20240215001018 |
| Provider Name | Catherine T Goffreda |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225396815 PECOS PAC ID: 3779927405 Enrollment ID: I20240221000742 |
| Provider Name | Cody L Granda |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194976555 PECOS PAC ID: 8628412301 Enrollment ID: I20240221002356 |
| Provider Name | Judith A Black |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003110198 PECOS PAC ID: 6406206697 Enrollment ID: I20240222002314 |
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