Individual
DR. CAROLYN H SUPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
1108 SWAN RD, CHARLESTON, WV 25314-1426
(304) 345-3685
Mailing address
1108 SWAN RD, CHARLESTON, WV 25314-1426
(304) 345-3685
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
643
WV
Other
Enumeration date
06/08/2007
Last updated
07/08/2007
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