Provider Demographics
NPI:1023148624
Name:O'CONNELL, GINGER MORTIMER
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:MORTIMER
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:MORTIMER
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,RN,NCC,LPC,ALPS
Mailing Address - Street 1:213 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3221
Mailing Address - Country:US
Mailing Address - Phone:304-263-0345
Mailing Address - Fax:304-263-0367
Practice Address - Street 1:213 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3221
Practice Address - Country:US
Practice Address - Phone:304-263-0345
Practice Address - Fax:304-263-0367
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional