Provider Demographics
NPI:1699215038
Name:WILEY, LAURA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-522-1133
Mailing Address - Fax:304-522-1134
Practice Address - Street 1:2585 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1642
Practice Address - Country:US
Practice Address - Phone:304-781-5138
Practice Address - Fax:304-781-5139
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941473104100000X
WV2272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker