Individual
MARK VINCENT SUNDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.,LICSW
Contact information
Practice address
209 W MAPLE AVE, FAYETTEVILLE, WV 25840-1413
(304) 574-2100
(304) 574-2151
Mailing address
209 W MAPLE AVE, FAYETTEVILLE, WV 25840-1413
(304) 574-2100
(304) 574-2151
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00450472
WV
Other
Enumeration date
05/08/2007
Last updated
07/09/2007
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