Provider Demographics
NPI:1740414473
Name:KRADEL, COLLEEN BOHLANDER (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:BOHLANDER
Last Name:KRADEL
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 1:375 SYMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7268
Mailing Address - Country:US
Mailing Address - Phone:540-532-0220
Mailing Address - Fax:
Practice Address - Street 1:316 W STEPHEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3242
Practice Address - Country:US
Practice Address - Phone:540-532-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP029433491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical