Individual
CONSTANCE J BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
930 CHESTNUT RIDGE RD, MORGANTOWN, WV 26505-2807
(304) 598-4214
Mailing address
PO BOX 780, MORGANTOWN, WV 26507-0780
(304) 293-7401
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2018
WV
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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