Provider Demographics
NPI:1235528803
Name:COURAGE IN HEALING
Entity Type:Organization
Organization Name:COURAGE IN HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC
Authorized Official - Phone:304-291-2912
Mailing Address - Street 1:1102 ABOUT TOWN PL
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5826
Mailing Address - Country:US
Mailing Address - Phone:304-291-2912
Mailing Address - Fax:304-291-2918
Practice Address - Street 1:1102 ABOUT TOWN PL
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5826
Practice Address - Country:US
Practice Address - Phone:304-291-2912
Practice Address - Fax:304-291-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1861742801OtherNPI
1720411788OtherNPI
WV1720164908OtherNPI
PA1982871448OtherNPI