| NPI | 1104165216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREAMA SHORT Licensed Professional Counselor 304-763-7088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WV 1361) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WV 1054) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2013-02-08 |