Organization
GREENRIVER ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBEKAH MARIE NICHOLSON-LILLY (SPEECH PATHOLOGIST)
(304) 667-3448
Entity
Organization
Contact information
Practice address
722 MAIN ST E, WHITE SULPHUR SPRINGS, WV 24986-3002
(130) 466-7344
Mailing address
722 MAIN ST E, WHITE SULPHUR SPRINGS, WV 24986-3002
(130) 466-7344
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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