Provider Demographics
NPI:1417360348
Name:KRAFFT, GILLIAN (LICSW)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:KRAFFT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1876
Mailing Address - Country:US
Mailing Address - Phone:304-381-2211
Mailing Address - Fax:304-206-3121
Practice Address - Street 1:1277 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1876
Practice Address - Country:US
Practice Address - Phone:304-381-2211
Practice Address - Fax:304-206-3121
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WVDP009448021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker