Provider Demographics
NPI:1003987199
Name:JUSTICE, PAULETTE SUSAN (LPC, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:SUSAN
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NOYES AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1518
Mailing Address - Country:US
Mailing Address - Phone:304-766-4572
Mailing Address - Fax:304-766-4599
Practice Address - Street 1:4825 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-766-4572
Practice Address - Fax:304-766-4599
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV194101YP2500X
WVCP004538681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical