Provider Demographics
NPI:1205834389
Name:CALLAHAN, PETER JOSEPH (LGSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:CALLAHAN COUNSELING
Other - Middle Name:
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1074
Mailing Address - Country:US
Mailing Address - Phone:304-886-4118
Mailing Address - Fax:304-579-8606
Practice Address - Street 1:1020 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1650
Practice Address - Country:US
Practice Address - Phone:304-886-4118
Practice Address - Fax:304-579-8606
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP099661481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000505Medicaid