Provider Demographics
NPI:1366913204
Name:CADLE, MISTY AMBER (MED, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:AMBER
Last Name:CADLE
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:AMBER
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2322
Mailing Address - Country:US
Mailing Address - Phone:276-202-8814
Mailing Address - Fax:
Practice Address - Street 1:108 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2322
Practice Address - Country:US
Practice Address - Phone:276-202-8814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103104101YA0400X
WV2376101YA0400X, 101YM0800X, 101YP2500X
VA0701007545101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1427511278Medicaid