Provider Demographics
NPI:1336023712
Name:LAURENS WISH ADDICTION TRIAGE CENTER INC
Entity type:Organization
Organization Name:LAURENS WISH ADDICTION TRIAGE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-282-7632
Mailing Address - Street 1:20 SCOTT AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8857
Mailing Address - Country:US
Mailing Address - Phone:304-241-4000
Mailing Address - Fax:304-212-5141
Practice Address - Street 1:20 SCOTT AVE STE 301
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8857
Practice Address - Country:US
Practice Address - Phone:304-241-4000
Practice Address - Fax:304-212-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder