Provider Demographics
NPI:1588303960
Name:SERIG, KEVIN (LGSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SERIG
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3548
Mailing Address - Country:US
Mailing Address - Phone:304-233-9627
Mailing Address - Fax:
Practice Address - Street 1:87 15TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3548
Practice Address - Country:US
Practice Address - Phone:304-233-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00940586104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker