Provider Demographics
NPI:1245826601
Name:UPHOLD, SENECA JEAN (LGSW)
Entity type:Individual
Prefix:MRS
First Name:SENECA
Middle Name:JEAN
Last Name:UPHOLD
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:MISS
Other - First Name:SENECA
Other - Middle Name:JEAN
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201
Mailing Address - Country:US
Mailing Address - Phone:304-473-5634
Mailing Address - Fax:
Practice Address - Street 1:133 STAUNTON DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452
Practice Address - Country:US
Practice Address - Phone:304-269-9510
Practice Address - Fax:304-472-1341
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00946090104100000X
WV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7728Medicaid