| NPI | 1669696589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NUSRATH HASAN Physician 304-425-6110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WV WV16821) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |