| NPI | 1376809186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK TANNER Executive Director 304-255-1397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |