Individual
REVITAL METRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1075 VAN VOORHIS RD STE 150, MORGANTOWN, WV 26505
(304) 598-6216
Mailing address
PO BOX 780, MORGANTOWN, WV 26507-0780
(304) 285-7101
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/29/2016
Last updated
09/04/2024
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