| NPI | 1942058243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GIBSON VP, Finance 304-598-4256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2024-05-10 |