Provider Demographics
NPI:1447534789
Name:COVILLE, HOLLY KELLY (MA, EDS)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:KELLY
Last Name:COVILLE
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROWNS RUN RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9459
Mailing Address - Country:US
Mailing Address - Phone:304-909-0185
Mailing Address - Fax:304-909-0188
Practice Address - Street 1:4453 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-2012
Practice Address - Country:US
Practice Address - Phone:304-909-0185
Practice Address - Fax:304-909-0188
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist