Basic Information
| Provider Information | |||||||||
| NPI: | 1942957857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | CASSANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 PHILPOTT LN | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258139501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042549262 | ||||||||
| FaxNumber: | 3042549263 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 PHILPOTT LN | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258139501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042549262 | ||||||||
| FaxNumber: | 3042549263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.