Organization
PORTICO ERC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH RAYANNE CICHOSKI LICSW (CLINICAL THERAPIST)
(304) 288-7928
Entity
Organization
Contact information
Practice address
1253 CANYON RD, MORGANTOWN, WV 26508-9273
(304) 898-8389
Mailing address
245 WAITMAN ST, MORGANTOWN, WV 26501-7545
(304) 288-7928
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/12/2022
Last updated
08/12/2022
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