| NPI | 1508306978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LEGG Director 304-647-1389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2017-03-03 |