| NPI | 1386738508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM L THISTLETHWAITE Owner 304-205-5207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 17498) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WV 1225) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-10-04 |