Provider Demographics
NPI:1992968192
Name:ACKERMANN, CAROL (MA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ACKERMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 RITTER DRIVE
Mailing Address - Street 2:P.O. BOX 40
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-7707
Mailing Address - Country:US
Mailing Address - Phone:304-255-2043
Mailing Address - Fax:304-255-2043
Practice Address - Street 1:673 RITTER DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-7707
Practice Address - Country:US
Practice Address - Phone:304-255-2043
Practice Address - Fax:304-255-2043
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAP00941291OtherSOCIAL WORK