Individual
PHILLIP WANE HAYWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LGSW
Contact information
Practice address
200 VETERANS AVE, BECKLEY, WV 25801-6444
(304) 255-2121
Mailing address
200 VETERANS AVE, BECKLEY, WV 25801-6444
(304) 255-2121
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00945784
WY
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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