Organization
POLONCHAK EDUCATIONAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHY POLONCHAK LICSW (VICE PRESIDENT)
(304) 876-1421
Entity
Organization
Contact information
Practice address
129 E. GERMAN ST., SHEPHERDSTOWN, WV 25443
(304) 876-3022
(304) 876-1421
Mailing address
234 DEER MOUNTAIN DR, HARPERS FERRY, WV 25425-5490
(304) 876-1421
(304) 876-1421
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00940860
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598984833
NIP TYPE I
WV
Enumeration date
05/14/2007
Last updated
06/25/2008
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