Provider Demographics
NPI:1215735980
Name:WALLFLOWER CONNECTION THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:WALLFLOWER CONNECTION THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:304-322-0267
Mailing Address - Street 1:3292 UNIVERSITY AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2279
Mailing Address - Country:US
Mailing Address - Phone:304-322-0267
Mailing Address - Fax:304-322-0267
Practice Address - Street 1:3292 UNIVERSITY AVE APT 606
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2279
Practice Address - Country:US
Practice Address - Phone:304-322-0267
Practice Address - Fax:304-322-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty