Provider Demographics
NPI:1437274263
Name:LALOS, GENISE LYNN (LSW, CAC)
Entity Type:Individual
Prefix:
First Name:GENISE
Middle Name:LYNN
Last Name:LALOS
Suffix:
Gender:F
Credentials:LSW, CAC
Other - Prefix:
Other - First Name:GENISE
Other - Middle Name:LYNN
Other - Last Name:HEFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, CAC
Mailing Address - Street 1:2 ROBIN LN
Mailing Address - Street 2:SHERWOOD ESTATES
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9749
Mailing Address - Country:US
Mailing Address - Phone:304-736-6874
Mailing Address - Fax:304-697-1286
Practice Address - Street 1:1420 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1519
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-697-1286
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV95-302S101YA0400X
WVAP009402191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAP00940219OtherLSW
WV95-102SOtherCCS
WV95-302SOtherCCAC