Organization
DEVELOPMENTAL EVOLUTION, LLC
Active
Other names
Mental and Social Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHOR MSW (MEMBER)
(304) 725-4160
Entity
Organization
Contact information
Practice address
667 HUYETT RD, CHARLES TOWN, WV 25414-5378
(304) 725-4160
Mailing address
44 PADDOCK PL, CHARLES TOWN, WV 25414-5329
(304) 725-4160
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BP00944336
WV
Other
Enumeration date
06/15/2014
Last updated
06/15/2014
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