Provider Demographics
NPI:1174666879
Name:CAIN, PERRY LEE (MA)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LEE
Last Name:CAIN
Suffix:
Gender:M
Credentials:MA
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 1676
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26302-1676
Mailing Address - Country:US
Mailing Address - Phone:304-622-4786
Mailing Address - Fax:304-622-7210
Practice Address - Street 1:443 W PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2711
Practice Address - Country:US
Practice Address - Phone:304-622-4786
Practice Address - Fax:304-622-7210
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1202101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral