Organization
FAMILY SERVICE, DIV. OF GOODWILL INDUSTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISSA STEWART (EXECUTIVE DIRECTOR)
(304) 523-9454
Entity
Organization
Contact information
Practice address
1102 MEMORIAL BLVD W, HUNTINGTON, WV 25701-4540
(304) 523-9454
Mailing address
1102 MEMORIAL BLVD W, HUNTINGTON, WV 25701-4540
(304) 523-9454
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
408
WV
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
408
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810018235
—
WV
05
—
3810018236
—
WV
Enumeration date
12/09/2015
Last updated
12/14/2015
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