Basic Information
Provider Information | |||||||||
NPI: | 1528588563 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HEMLEPP | ||||||||
FirstName: | AARON | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LGSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6775 POINT PLEASANT RD | ||||||||
Address2: |   | ||||||||
City: | MILLWOOD | ||||||||
State: | WV | ||||||||
PostalCode: | 252628100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042730112 | ||||||||
FaxNumber: | 3042730115 | ||||||||
Practice Location | |||||||||
Address1: | 7400 LYNN AVE | ||||||||
Address2: |   | ||||||||
City: | HAMLIN | ||||||||
State: | WV | ||||||||
PostalCode: | 25523 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042730112 | ||||||||
FaxNumber: | 3042730115 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/21/2017 | ||||||||
LastUpdateDate: | 06/21/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | BP00944613 | WV | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
ID Information
ID | Type | State | Issuer | Description | BP00944613 | 01 | WV | SOCIAL WORK | OTHER |