Provider Demographics
NPI:1023141041
Name:CAMC FAMILY RESOURCE CENTER
Entity type:Organization
Organization Name:CAMC FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FAMILY RESOURCE CENTER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LPC
Authorized Official - Phone:304-388-1596
Mailing Address - Street 1:800 PENNSYLVANIA AVE
Mailing Address - Street 2:FAMILY RESOURCE CENTER
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3351
Mailing Address - Country:US
Mailing Address - Phone:304-388-1596
Mailing Address - Fax:304-388-2781
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:FAMILY RESOURCE CENTER
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:304-388-1596
Practice Address - Fax:304-388-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 1813261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health