Organization
SOULMOSAIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA NICOLE MATALA LICSW (OWNER)
(304) 685-8967
Entity
Organization
Contact information
Practice address
240 SCOTT AVE STE 4, MORGANTOWN, WV 26508-8805
(304) 685-8967
Mailing address
509 LAKE ST, MORGANTOWN, WV 26505-3312
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP00944408
LISCW
WV
Enumeration date
05/19/2021
Last updated
05/19/2021
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