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Individual

JUSTIN RONALD WINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1540 SPRING VALLEY DR, HUNTINGTON, WV 25704-9501
(304) 429-6741
Mailing address
119 NORTH TER, HUNTINGTON, WV 25705-1533

Taxonomy

Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
374K00000X
Religious Nonmedical Practitioner

Other

Enumeration date
08/01/2023
Last updated
08/01/2023
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