Provider Demographics
NPI:1609073261
Name:MOOREHEAD, CATHERINE MARIE (CDMS, CMC, QRP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:CDMS, CMC, QRP
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 81
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-0081
Mailing Address - Country:US
Mailing Address - Phone:304-574-2950
Mailing Address - Fax:304-574-2958
Practice Address - Street 1:131 DANIELS ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1215
Practice Address - Country:US
Practice Address - Phone:304-574-2950
Practice Address - Fax:304-574-2958
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00000260171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00000260OtherQRP
OH281745303-00OtherPROVIDER NUMBER, OBWC
WV00044981OtherCDMS