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119 Sader Dr Ste 4 Inwood WV 25428-3915 | |
| (304) 278-3010 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 119 Sader Dr Ste 4, Inwood, West Virginia |
| Authorized Official Name and Position | Lorie Mullan (OWNER) |
| Authorized Official Contact | 3042783010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 92 Inwood WV 25428-0092 Ph: (304) 278-3010 | 119 Sader Dr Ste 4 Inwood WV 25428-3915 Ph: (304) 278-3010 |
| NPI Number | 1598369779 |
|---|---|
| Provider Enumeration Date | 11/28/2020 |
| Last Update Date | 11/11/2024 |
| Certification Date | 11/11/2024 |
| Medicare PECOS PAC ID | 9638575095 |
|---|---|
| Medicare Enrollment ID | O20210909002692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598369779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lorie Lynn Mullan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326569583 PECOS PAC ID: 0547666901 Enrollment ID: I20210909002988 |
West Virginia University Medical Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5047 Gerrardstown Rd Ste 2b, Inwood, WV 25428 Phone: 304-821-1444 Fax: 304-821-1470 | |