Provider Demographics
NPI:1992150809
Name:CREMEANS, MICHELLE NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE
Last Name:CREMEANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 299
Mailing Address - Street 2:252 COURTHOUSE DRIVE
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9370
Mailing Address - Country:US
Mailing Address - Phone:304-586-0670
Mailing Address - Fax:304-586-0671
Practice Address - Street 1:710 VIAND STREET
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1250
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WV0005355002Medicaid