| NPI | 1053169870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GIBSON VP, Finance 304-598-4256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 170300000X Genetic Counselor, MS | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-05-07 |