Individual
RUSSEL R BRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LGSW
Contact information
Practice address
200 VETERANS AVE, BECKLEY, WV 25801-6444
(304) 255-2121
Mailing address
676 TUG CREEK MT ROAD, HINTON, WV 25951
(304) 207-3226
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00945034
WV
1041C0700X
Clinical Social Worker
BP00945034
WV
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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