Organization
PNB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON HUGHART (EXECUTIVE DIRECTOR)
(304) 222-1132
Entity
Organization
Contact information
Practice address
1289 ROBERT C BYRD DR, SUITE 4, CRAB ORCHARD, WV 25827
(304) 253-8979
Mailing address
110 GAINES AVE, BECKLEY, WV 25801-8687
(304) 222-1132
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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