| NPI | 1043684699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A GRAY Psychologist 304-676-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WV WV1107) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2022-04-25 |