Provider Demographics
NPI:1316385792
Name:JUDE, DANNY ERNEST JR (LICSW)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:ERNEST
Last Name:JUDE
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20824 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-7074
Mailing Address - Country:US
Mailing Address - Phone:304-648-7100
Mailing Address - Fax:304-648-7160
Practice Address - Street 1:20824 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-7074
Practice Address - Country:US
Practice Address - Phone:304-648-7100
Practice Address - Fax:304-648-7160
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
KY50411041C0700X
WVDP009447831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor