Provider Demographics
NPI:1790163525
Name:PRATHER, PROMISE
Entity Type:Individual
Prefix:
First Name:PROMISE
Middle Name:
Last Name:PRATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENTON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1266
Mailing Address - Country:US
Mailing Address - Phone:304-347-9818
Mailing Address - Fax:304-347-9820
Practice Address - Street 1:832 NEVILLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4342
Practice Address - Country:US
Practice Address - Phone:304-929-4130
Practice Address - Fax:304-929-4134
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional