Provider Demographics
NPI:1912008129
Name:TALKINGTON, MARK EDWARD (MSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:TALKINGTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 62 BOX 80A
Mailing Address - Street 2:
Mailing Address - City:ALVY
Mailing Address - State:WV
Mailing Address - Zip Code:26377-9510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:#1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4199
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-626-7726
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00940562104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker