Individual
SHONTAE ALEXIS COX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
816 HARRISON ST, PRINCETON, WV 24740-3009
(681) 439-1747
Mailing address
816 HARRISON ST, PRINCETON, WV 24740-3009
(681) 439-1747
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005489001
—
WV
Enumeration date
06/30/2017
Last updated
02/06/2023
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