Provider Demographics
NPI:1780197244
Name:FRICK, KEVIN WAYNE (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WAYNE
Last Name:FRICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SOUTH STREETCAR WAY
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385
Mailing Address - Country:US
Mailing Address - Phone:304-623-5661
Mailing Address - Fax:304-623-2989
Practice Address - Street 1:43 SOUTH STREETCAR WAY
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385
Practice Address - Country:US
Practice Address - Phone:304-745-5065
Practice Address - Fax:304-745-5067
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional