Provider Demographics
NPI:1366283814
Name:MASON, MARYANNA MARIE (NCC)
Entity type:Individual
Prefix:
First Name:MARYANNA
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 LINKS DR
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-5503
Mailing Address - Country:US
Mailing Address - Phone:304-672-3139
Mailing Address - Fax:
Practice Address - Street 1:1005 WHITE WILLOW WAY
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-6119
Practice Address - Country:US
Practice Address - Phone:304-212-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WV922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor