| NPI | 1811281611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE AMMONS Clinical Therapist 304-218-0895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WV 2007) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OH C0700218) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |