Provider Demographics
NPI:1194047548
Name:PROUDFOOT HARMAN, PEGGY JO (LICSW)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:JO
Last Name:PROUDFOOT HARMAN
Suffix:
Gender:F
Credentials:LICSW
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 1392
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25715-1392
Mailing Address - Country:US
Mailing Address - Phone:304-696-3751
Mailing Address - Fax:
Practice Address - Street 1:320 18TH ST.
Practice Address - Street 2:GULLICKSON HALL SUITE G01
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703
Practice Address - Country:US
Practice Address - Phone:304-691-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15530101YM0800X
WVDP009451891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health