Provider Demographics
NPI:1467538686
Name:MINK, DANIEL C (MA)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:MINK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:1014 JOHNSTOWN ROAD
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1128
Mailing Address - Country:US
Mailing Address - Phone:304-252-4433
Mailing Address - Fax:304-252-1703
Practice Address - Street 1:1014 JOHNSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4940
Practice Address - Country:US
Practice Address - Phone:304-252-4433
Practice Address - Fax:304-252-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004530Medicaid
WV0116820000Medicaid
WV0116820000Medicaid
WV3810004530Medicaid