Organization
COUNCIL OF THE SOUTHERN MOUNTAINS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDAL JOHNSON (EXECUTIVE DIRECTOR)
(304) 862-3144
Entity
Organization
Contact information
Practice address
69 MAIN ST., NORTHFORK, WV 24868-0085
(304) 862-3144
(304) 862-3071
Mailing address
PO BOX 85, 69 MAIN ST., NORTHFORK, WV 24868-0085
(304) 862-3144
(304) 862-3071
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
384
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009682
—
WV
05
—
3810009683
—
WV
Enumeration date
12/06/2007
Last updated
12/06/2007
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