Individual
MRS. NICOLE JANE SIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
971 HARRISON AVE, YOUTH HEALTH SERVICE, ELKINS, WV 26241
(304) 636-9450
(304) 636-7057
Mailing address
108 VALLEY COURT, ELKINS, WV 26241
(304) 636-3853
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
AP00942414
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023397001
—
WV
Enumeration date
06/13/2007
Last updated
07/08/2007
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