| NPI | 1144351024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA RYAN Owner 304-235-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 811) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: WV 811) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |