Organization
HOME BASE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMON CASE CATER OWNER, CEO (OWNER, CEO)
(304) 746-2918
Entity
Organization
Contact information
Practice address
713 BIGLEY AVE, CHARLESTON, WV 25302-3356
(304) 746-2918
(304) 746-2919
Mailing address
PO BOX 20033, CHARLESTON, WV 25362-1033
(304) 746-2918
(304) 746-2919
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
440
WV
101YM0800X
Mental Health Counselor
440
WV
101YP2500X
Professional Counselor
440
WV
103T00000X
Psychologist
440
WV
251S00000X
Community/Behavioral Health Agency
Primary
440
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440
WEST VIRGINIA BEHAVIORAL HEALTHCARE LICENSE
WV
05
—
9435000000
—
WV
05
—
9435000001
—
WV
Enumeration date
06/14/2016
Last updated
06/14/2016
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