Provider Demographics
NPI:1447692520
Name:HUFFORD, FREDERICK MICHAEL (M A)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:HUFFORD
Suffix:
Gender:M
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 STAUNTON AVE .SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-925-2602
Mailing Address - Fax:
Practice Address - Street 1:910 QUARRIER ST
Practice Address - Street 2:SUITE 410-411
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2613
Practice Address - Country:US
Practice Address - Phone:304-345-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health