Individual
AVIS LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
785 SUMMERSVILLE LAKE RD, MOUNT NEBO, WV 26679-9203
(304) 883-2334
Mailing address
PO BOX 569, MOUNT NEBO, WV 26679-0569
(304) 883-2334
(304) 883-2334
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
WV
Other
Enumeration date
01/14/2026
Last updated
01/14/2026
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