Provider Demographics
NPI:1689655532
Name:WEISBROD, JO A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:WEISBROD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 40 BOX 41
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-8811
Mailing Address - Country:US
Mailing Address - Phone:304-647-3311
Mailing Address - Fax:304-645-2372
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1327
Practice Address - Country:US
Practice Address - Phone:304-647-3311
Practice Address - Fax:304-645-2372
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health