Provider Demographics
NPI:1790059152
Name:ARBOGAST, ALEISHA GAIL (MA)
Entity Type:Individual
Prefix:MRS
First Name:ALEISHA
Middle Name:GAIL
Last Name:ARBOGAST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:VALLEY HEAD
Mailing Address - State:WV
Mailing Address - Zip Code:26294-0097
Mailing Address - Country:US
Mailing Address - Phone:304-339-3318
Mailing Address - Fax:
Practice Address - Street 1:240 ALLEGHENY HWY
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5749
Practice Address - Country:US
Practice Address - Phone:304-636-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1790059152Medicaid