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102 Patrick Street Plz Charleston WV 25387-2444 | |
| (304) 941-9779 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 102 Patrick Street Plz, Charleston, West Virginia |
| Authorized Official Name and Position | Joseph Shaffer (COO) |
| Authorized Official Contact | 8594892705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8 River Walk Mall South Charleston WV 25303-1026 Ph: () - | 102 Patrick Street Plz Charleston WV 25387-2444 Ph: (304) 941-9779 |
| NPI Number | 1194294587 |
|---|---|
| Provider Enumeration Date | 11/15/2018 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194294587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
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