| NPI | 1689165508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CIPOLETTI DERREBERRY Managing Member 304-617-4337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2016-01870) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2020-06-10 |