Individual
MRS. MARY PRENTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
136 SULLIVAN RD, GLEN MORGAN, WV 25813-7600
(304) 256-4500
Mailing address
136 SULLIVAN RD, GLEN MORGAN, WV 25813-7600
(304) 256-4500
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
10049
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0165891000
—
WV
Enumeration date
03/06/2008
Last updated
03/06/2008
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