Provider Demographics
NPI:1255803011
Name:LAUGHLIN, JAMI
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:LAUGHLIN
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 1:797 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:IVYDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25113-8263
Mailing Address - Country:US
Mailing Address - Phone:304-286-4200
Mailing Address - Fax:304-286-2107
Practice Address - Street 1:797 CLINIC DR
Practice Address - Street 2:
Practice Address - City:IVYDALE
Practice Address - State:WV
Practice Address - Zip Code:25113-8263
Practice Address - Country:US
Practice Address - Phone:304-286-4200
Practice Address - Fax:304-286-2107
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015614Medicaid