| NPI | 1548519887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ELIZABETH BOWLES Billing/Credentialing Specialist 304-340-3676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 2020) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2012-08-31 |