| NPI | 1619022084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES CAPAGE Member 304-599-5073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 507) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WV 112) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2008-04-20 |