Provider Demographics
NPI:1396483731
Name:CENTRAL AVENUE WELLNESS
Entity type:Organization
Organization Name:CENTRAL AVENUE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-638-2564
Mailing Address - Street 1:652 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1314
Mailing Address - Country:US
Mailing Address - Phone:304-638-2564
Mailing Address - Fax:
Practice Address - Street 1:652 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1314
Practice Address - Country:US
Practice Address - Phone:304-638-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty