| NPI | 1558736082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISSA STEWART Executive Director 304-523-9454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WV 408) |
| Additional Taxonomies | 261QM0801X (Licence: WV 408) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-14 |