| Soulmosaic, Pllc | |
|
240 Scott Ave Ste 4 Morgantown WV 26508-8805 | |
| (304) 685-8967 | |
| Not Available |
| Full Name | Soulmosaic, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 240 Scott Ave Ste 4, Morgantown, West Virginia |
| Authorized Official Name and Position | Jessica Nicole Matala (OWNER) |
| Authorized Official Contact | 3046858967 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soulmosaic, Pllc 509 Lake St Morgantown WV 26505-3312 Ph: () - | Soulmosaic, Pllc 240 Scott Ave Ste 4 Morgantown WV 26508-8805 Ph: (304) 685-8967 |
| NPI Number | 1013581404 |
|---|---|
| Provider Enumeration Date | 05/19/2021 |
| Last Update Date | 05/19/2021 |
| Certification Date | 05/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013581404 | NPI | - | NPPES |
| DP00944408 | Other | WV | LISCW |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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