Individual
DONOVAN GROOMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
2157 GREENBRIER ST, CHARLESTON, WV 25311-9623
(304) 550-8613
Mailing address
5449 LONGVIEW DR, CROSS LANES, WV 25313-1514
(304) 550-8613
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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