Provider Demographics
NPI:1154695955
Name:MEDINA, AARON C (LPC)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:C
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:INDUSTRIAL
Mailing Address - State:WV
Mailing Address - Zip Code:26426-1244
Mailing Address - Country:US
Mailing Address - Phone:304-782-2371
Mailing Address - Fax:
Practice Address - Street 1:7 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:INDUSTRIAL
Practice Address - State:WV
Practice Address - Zip Code:26426-1244
Practice Address - Country:US
Practice Address - Phone:304-782-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005174101YP2500X
WV2064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional