| Doctor Name: | JASON GINEVAN |
| NPI Number: | 1376917005 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ADC |
| License Number: | 99-118 |
| Business Practice Address: | 55 N Bolton St Suite 100 Romney, WV - 267571635 |
| Business Phone Number: | 3043592245 |
| Business Fax Number: | 3043592259 |
| Mailing Address: | 55 N Bolton St, Suite 100 ROMNEY |
| State: | WV |
| Postal Code: | 267571635 |
| Phone Number: | 3043592245 |
| Fax Number: | 3043592259 |
| NPI Enumeration Date: | 11/18/2015 |
| NPI Last Update Date: | 11/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 99-118 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |