| NPI | 1790080307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT HANSEN Executive Director 304-399-1133 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 14902) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 1213) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: WV 71510) | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2015-10-21 |