| NPI | 1326726886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA E DANIELS Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2023-07-06 |