Provider Demographics
NPI:1609015999
Name:NEWSOME, JASON E (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8880
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303
Mailing Address - Country:US
Mailing Address - Phone:304-415-2410
Mailing Address - Fax:855-314-6877
Practice Address - Street 1:2390 KANAWHA STATE FOREST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-9080
Practice Address - Country:US
Practice Address - Phone:304-415-2410
Practice Address - Fax:855-314-6877
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional