Provider Demographics
NPI:1649337262
Name:DAGUE, BETH ANN (MS LPC MSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:DAGUE
Suffix:
Gender:F
Credentials:MS LPC MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6710
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-233-4435
Mailing Address - Fax:304-233-4436
Practice Address - Street 1:2204 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-233-4435
Practice Address - Fax:304-233-4436
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV314101YP2500X
WVCP00452275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
235425OtherCOMPSYCH
7167298OtherAETNA
WVY1040497AOtherTHE HEALTH PLAN
295050OtherMANAGED HEALTH NETWORK
WV063637OtherVALUE OPTIONS