Provider Demographics
NPI:1720498835
Name:HUGHES, CAROL ANNETTE (MS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNETTE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:C.
Other - Middle Name:ANNETTE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9008
Mailing Address - Country:US
Mailing Address - Phone:304-933-3885
Mailing Address - Fax:304-933-3887
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9008
Practice Address - Country:US
Practice Address - Phone:304-933-3885
Practice Address - Fax:304-933-3887
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV498103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist