Individual
JERRICA C STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
120 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4599
(304) 460-5123
Mailing address
437 BROADWAY AVE, BRIDGEPORT, WV 26330-1506
(304) 641-7677
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW062316664
WV
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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