| NPI | 1245653864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM R COBURN Owner 304-650-3820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WV 1683) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: PA PC003414) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-03 |