Basic Information
| Provider Information | |||||||||
| NPI: | 1023141041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMC FAMILY RESOURCE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PENNSYLVANIA AVE | ||||||||
| Address2: | FAMILY RESOURCE CENTER | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881596 | ||||||||
| FaxNumber: | 3043882781 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 PENNSYLVANIA AVE | ||||||||
| Address2: | FAMILY RESOURCE CENTER | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881596 | ||||||||
| FaxNumber: | 3043882781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURGESS | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, FAMILY RESOURCE CENTER | ||||||||
| AuthorizedOfficialTelephone: | 3043881596 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | WV 1813 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.