Provider Demographics
NPI:1831198662
Name:LOUGHRIDGE, FANNIE ELAINE (MA LPC ADC)
Entity type:Individual
Prefix:MRS
First Name:FANNIE
Middle Name:ELAINE
Last Name:LOUGHRIDGE
Suffix:
Gender:F
Credentials:MA LPC ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0283
Mailing Address - Country:US
Mailing Address - Phone:304-733-1833
Mailing Address - Fax:304-733-4833
Practice Address - Street 1:642 BRADY ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1340
Practice Address - Country:US
Practice Address - Phone:304-733-1833
Practice Address - Fax:304-733-4833
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV20-8258265OtherTAX ID NUMBER