Provider Demographics
NPI:1487166518
Name:BARR, KARISSA (MA COUNSELOR)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:MA COUNSELOR
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA COUNSELOR
Mailing Address - Street 1:1000 5TH AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2238
Mailing Address - Country:US
Mailing Address - Phone:304-733-0036
Mailing Address - Fax:
Practice Address - Street 1:1000 5TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2238
Practice Address - Country:US
Practice Address - Phone:304-733-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001251Medicaid