Provider Demographics
NPI:1356455091
Name:FAMILY SERVICE OF MARION & HARRISON COUNTIES INC
Entity Type:Organization
Organization Name:FAMILY SERVICE OF MARION & HARRISON COUNTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:304-366-4750
Mailing Address - Street 1:1313 LOCUST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1435
Mailing Address - Country:US
Mailing Address - Phone:304-366-4750
Mailing Address - Fax:304-366-4753
Practice Address - Street 1:1313 LOCUST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1435
Practice Address - Country:US
Practice Address - Phone:304-366-4750
Practice Address - Fax:304-366-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV129101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023793001Medicaid
WV0023793003Medicaid
WV0023793000Medicaid
WV0023793004Medicaid
WV001709325OtherBLUE CROSS BLUE SHIELD