Organization
NATIONAL YOUTH ADVOCATE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE ELLENBERGER MSW.LGSW (EXECUTIVE DIRECTOR, WV)
(304) 363-4237
Entity
Organization
Contact information
Practice address
909 MORGANTOWN AVE, FAIRMONT, WV 26554-4335
(304) 366-5832
(304) 366-5863
Mailing address
909 MORGANTOWN AVE, FAIRMONT, WV 26554-4335
(304) 366-5832
(304) 366-5863
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
97
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023630001
—
WV
Enumeration date
05/03/2007
Last updated
02/20/2026
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