| Graceway Counseling Center | |
|
744 4th Ave Ste 2 Huntington WV 25701-1541 | |
| (304) 691-0873 | |
| (304) 955-9057 |
| Full Name | Graceway Counseling Center |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 744 4th Ave Ste 2, Huntington, West Virginia |
| Authorized Official Name and Position | Matthew Maynard (OWNER) |
| Authorized Official Contact | 3046910873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceway Counseling Center 33 Walnut Ln Huntington WV 25704-9485 Ph: (304) 638-1551 | Graceway Counseling Center 744 4th Ave Ste 2 Huntington WV 25701-1541 Ph: (304) 691-0873 |
| NPI Number | 1003405978 |
|---|---|
| Provider Enumeration Date | 01/14/2021 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/26/2024 |
| Medicare PECOS PAC ID | 2264894963 |
|---|---|
| Medicare Enrollment ID | O20230811002420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003405978 | NPI | - | NPPES |
| Provider Name | Rebeka A Copley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376090050 PECOS PAC ID: 4486922317 Enrollment ID: I20170619002048 |
| Provider Name | Thomas Lester |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962809293 PECOS PAC ID: 9537504584 Enrollment ID: I20240229000571 |
| Provider Name | Jacqueline Rollyson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275292054 PECOS PAC ID: 6800231861 Enrollment ID: I20240229000938 |
| Provider Name | Matthew Maynard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750970711 PECOS PAC ID: 4486638244 Enrollment ID: I20240306001335 |
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