Provider Demographics
NPI:1679920839
Name:PAYNE, EFFIE (LSW)
Entity type:Individual
Prefix:
First Name:EFFIE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 1/2 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1614
Mailing Address - Country:US
Mailing Address - Phone:304-312-6157
Mailing Address - Fax:
Practice Address - Street 1:1 HALLORAN DRIVE
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-296-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0027449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker