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Individual

MRS. LOTHELL PACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A., ED.S.

Contact information

Practice address
66 SCHOOL ST, LOGAN, WV 25601-9605
(304) 792-2087
(304) 752-7471
Mailing address
66 SCHOOL ST, LOGAN, WV 25601-9605
(304) 792-2087
(304) 752-7471

Taxonomy

Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
21037
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0166298000
WV
Enumeration date
11/02/2006
Last updated
07/08/2007
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