Provider Demographics
NPI:1003971334
Name:CONRAD, JUDITH ELIZABETH (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58275
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25358
Mailing Address - Country:US
Mailing Address - Phone:304-744-5000
Mailing Address - Fax:304-744-6677
Practice Address - Street 1:BOX 405L
Practice Address - Street 2:ROUTE 8
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-744-5000
Practice Address - Fax:304-744-6677
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional