| Same | |
|
65 Woods Edge Rd Unit 6 Fort Ashby WV 26719-9292 | |
| (442) 347-7045 | |
| Not Available |
| Full Name | Same |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 65 Woods Edge Rd Unit 6, Fort Ashby, West Virginia |
| Authorized Official Name and Position | Nicolas Nguh Santo (PSYCHOLOGIST & SOCIAL WORKER) |
| Authorized Official Contact | 4423477045 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Same 65 Woods Edge Rd Unit 6 Fort Ashby WV 26719-9292 Ph: (442) 347-7045 | Same 65 Woods Edge Rd Unit 6 Fort Ashby WV 26719-9292 Ph: (442) 347-7045 |
| NPI Number | 1992385678 |
|---|---|
| Provider Enumeration Date | 04/08/2021 |
| Last Update Date | 04/08/2021 |
| Certification Date | 04/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992385678 | NPI | - | NPPES |
| RG092015619 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |