Individual
KYLE FETHEROLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
1402 4TH AVE, HUNTINGTON, WV 25701-2403
(304) 529-4276
Mailing address
1402 4TH AVE, HUNTINGTON, WV 25701-2403
(304) 529-4276
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
163662
OH
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
WV
Other
Enumeration date
10/23/2017
Last updated
10/27/2021
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