Organization
MOUNTAINEER LIFE ENRICHMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SEARS LICSW (CLINICAL SOCIAL WORKER)
(304) 373-4678
Entity
Organization
Contact information
Practice address
1522 BUNNER RIDGE RD, FAIRMONT, WV 26554-5079
(304) 373-4678
Mailing address
1522 BUNNER RIDGE RD, FAIRMONT, WV 26554-5079
(304) 373-4678
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
SELF PAY
—
Enumeration date
03/01/2023
Last updated
03/01/2023
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