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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
823 MADISON AVE, MORGANTOWN, WV 26501-6723
(304) 322-9922
(831) 708-2797
Mailing address
823 MADISON AVE, MORGANTOWN, WV 26501-6723
(304) 322-9922

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
726
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0165178002
WV
Enumeration date
07/18/2005
Last updated
02/21/2023
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