Provider Demographics
NPI:1962569491
Name:AMMONS, DENISE NOEL (MA, LSW, LPC, CCAC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:NOEL
Last Name:AMMONS
Suffix:
Gender:F
Credentials:MA, LSW, LPC, CCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-7174
Mailing Address - Fax:304-366-7419
Practice Address - Street 1:448 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3843
Practice Address - Country:US
Practice Address - Phone:304-366-7174
Practice Address - Fax:304-366-7419
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00942548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)