Individual
LAURA RUTH KUSRASHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
209 W MAPLE AVE, FAYETTEVILLE, WV 25840-1413
(304) 574-2100
(304) 574-2151
Mailing address
209 W MAPLE AVE, FAYETTEVILLE, WV 25840-1413
(304) 574-2100
(304) 574-2151
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
BP00944680
WV
1041C0700X
Clinical Social Worker
Primary
CP00944680
WV
Other
Enumeration date
07/03/2018
Last updated
08/25/2025
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