Individual
LISA A MATHAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
108 JOY WAY, FAIRMONT, WV 26554-9730
(304) 657-5252
Mailing address
108 JOY WAY, FAIRMONT, WV 26554-9730
(304) 657-5252
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CP00938863
WV
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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