Organization
POTOMAC HIGHLANDS GUILD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL D HENDRIX (A/R OFFICER)
(304) 257-1155
Entity
Organization
Contact information
Practice address
7 MOUNTAIN VIEW ST, PETERSBURG, WV 26847-1796
(304) 257-1555
(304) 257-1945
Mailing address
7 MOUNTAIN VIEW ST, PETERSBURG, WV 26847-1796
(130) 425-7115
(304) 257-1945
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1036-8848
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005473000
—
WV
05
—
0005473001
—
WV
05
—
0005473002
—
WV
Enumeration date
12/21/2009
Last updated
08/03/2022
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