Provider Demographics
NPI:1831543289
Name:ADVANTAGE
Entity type:Organization
Organization Name:ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONS SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, AADC
Authorized Official - Phone:304-346-8829
Mailing Address - Street 1:606 FORT HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1070
Mailing Address - Country:US
Mailing Address - Phone:304-346-8829
Mailing Address - Fax:304-346-8829
Practice Address - Street 1:2402 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2323
Practice Address - Country:US
Practice Address - Phone:304-389-5535
Practice Address - Fax:304-346-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV03-611251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2245-0179OtherWV STATE TAX DEPARTMENT BUSINESS REGISTRATION