| NPI | 1730990482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE A WELLS Director Of Provider Services 304-597-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-01-14 |