Provider Demographics
NPI:1669597936
Name:RADENHEIMER, L. ALLYSON (MA, LPC)
Entity type:Individual
Prefix:
First Name:L.
Middle Name:ALLYSON
Last Name:RADENHEIMER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ALLYSON
Other - Last Name:RADENHEIMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-0172
Mailing Address - Country:US
Mailing Address - Phone:304-760-9945
Mailing Address - Fax:
Practice Address - Street 1:200 KANAWHA TER STE 2
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2808
Practice Address - Country:US
Practice Address - Phone:304-760-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1065OtherFIRST STEPS CBIS