Provider Demographics
NPI:1790400349
Name:COUNTS, KATHERN ASHLEYMARIE
Entity Type:Individual
Prefix:
First Name:KATHERN
Middle Name:ASHLEYMARIE
Last Name:COUNTS
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 1:10 CROSSWIND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9118
Mailing Address - Country:US
Mailing Address - Phone:304-296-1731
Mailing Address - Fax:304-363-2228
Practice Address - Street 1:10 CROSSWIND DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9118
Practice Address - Country:US
Practice Address - Phone:304-296-1731
Practice Address - Fax:304-363-2228
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1609295112175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1609295112Medicaid
WVNAMedicaid