Organization
DAVIS-STUART, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A SPANGLER MA, LPC (EX. DIRECTOR)
(304) 647-5577
Entity
Organization
Contact information
Practice address
RR 2 BOX 188A, LEWISBURG, WV 24901-9320
(304) 647-5577
(304) 647-5727
Mailing address
RR 2 BOX 188A, LEWISBURG, WV 24901-9320
(304) 647-5577
(304) 647-5727
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
186
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0158860000
—
WV
01
—
30004935
SOCIAL SERVICES (WVDHHR)
WV
Enumeration date
04/17/2007
Last updated
08/22/2020
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