Provider Demographics
NPI:1083284707
Name:ELMO, PAULINA KRISTEN (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:KRISTEN
Last Name:ELMO
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BENONI AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2508
Mailing Address - Country:US
Mailing Address - Phone:681-404-6135
Mailing Address - Fax:
Practice Address - Street 1:701 BENONI AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2508
Practice Address - Country:US
Practice Address - Phone:681-404-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945952101Y00000X
SW041915059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor