Full Name | |
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Speciality | Community/behavioral Health |
Location | 25 Thistle Ln, Davis, West Virginia |
Authorized Official Name and Position | Elizabeth Simons (OWNER) |
Authorized Official Contact | 3048516643 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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25 Thistle Ln Davis WV 26260-1104 Ph: (304) 801-3258 | 25 Thistle Ln Davis WV 26260-1104 Ph: (304) 801-3258 |
NPI Number | 1225574544 |
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Provider Enumeration Date | 01/10/2017 |
Last Update Date | 03/17/2022 |
Certification Date | 03/17/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225574544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 0133000550 (Virginia) | Primary |