Organization
IMAGINE STATION WV LLC
Active
Parent organization
IMAGINATION STATION WV LLC
Other names
Imagination Station WV, Imagine Counseling Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMAGINATION STATION WV LLC
Authorized official
CANDACE D LAYNE LPC (DIRECTOR)
(304) 544-2417
Entity
Organization
Contact information
Practice address
709 3RD AVE, HUNTINGTON, WV 25701-1421
(304) 633-7751
Mailing address
709 3RD AVE, HUNTINGTON, WV 25701-1421
(304) 544-2417
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124273065
NPI NUMBER
—
Enumeration date
10/22/2021
Last updated
08/08/2022
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