Provider Demographics
NPI:1053987073
Name:TOLLEY, CASSIDY BROOKE (LGSW)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:BROOKE
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHURCH ST S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1614
Mailing Address - Country:US
Mailing Address - Phone:304-373-7010
Mailing Address - Fax:
Practice Address - Street 1:65 PROFESSIONAL PL STE 102103
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-0258
Practice Address - Country:US
Practice Address - Phone:304-992-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical