Provider Demographics
NPI:1396487138
Name:STOVER, DOUGLAS CLAYTON (ADC, CBCS, PRSS)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CLAYTON
Last Name:STOVER
Suffix:
Gender:M
Credentials:ADC, CBCS, PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8296 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LESAGE
Mailing Address - State:WV
Mailing Address - Zip Code:25537-9793
Mailing Address - Country:US
Mailing Address - Phone:681-378-3908
Mailing Address - Fax:304-759-8836
Practice Address - Street 1:1219 STEWART PLZ
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3021
Practice Address - Country:US
Practice Address - Phone:304-553-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X, 171M00000X, 101YA0400X
WVP7L5E7P3247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No171M00000XOther Service ProvidersCase Manager/Care Coordinator