Provider Demographics
NPI:1861257586
Name:RAYBURN, AARON CHAD
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:CHAD
Last Name:RAYBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 16TH STREET RD STE 11
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5247
Mailing Address - Country:US
Mailing Address - Phone:304-523-8387
Mailing Address - Fax:304-529-5910
Practice Address - Street 1:3135 16TH STREET RD STE 11
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5247
Practice Address - Country:US
Practice Address - Phone:304-523-8387
Practice Address - Fax:304-529-5910
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009446241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical