Organization
ADULT AND YOUTH SERVICES, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANA A NUGENT ED. D. (OWNER/PSYCHOLOGIST)
(304) 257-8232
Entity
Organization
Contact information
Practice address
1200 HARRISON AVE., SUITE 121, ELKINS, WV 26241-3392
(304) 636-4200
(304) 636-4200
Mailing address
PO BOX 44, DAVIS, WV 26260-0044
(304) 257-8232
(304) 636-4200
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2304-8074
WV
103TC0700X
Clinical Psychologist
999
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810017759
—
WV
Enumeration date
04/02/2015
Last updated
04/02/2015
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