| NPI | 1942689997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA YVONNE PEACOCK Administrative Director 304-917-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 965) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |