Individual
TANYA D. ZICKEFOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCAC
Contact information
Practice address
725 YOKUM ST, ELKINS, WV 26241-3353
(304) 636-3232
(304) 636-9243
Mailing address
205 RANDOLPH ST, BUCKHANNON, WV 26201-2309
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
02-309
WV
Other
Enumeration date
01/24/2007
Last updated
07/08/2007
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