Healthcare Provider Details

I. General information

NPI: 1770875213
Provider Name (Legal Business Name): ACHIEVEMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 CHERRY ST
BRIDGEPORT WV
26330-1569
US

IV. Provider business mailing address

PO BOX 1406
BRIDGEPORT WV
26330-6406
US

V. Phone/Fax

Practice location:
  • Phone: 304-365-4102
  • Fax:
Mailing address:
  • Phone: 304-365-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1012
License Number StateWV

VIII. Authorized Official

Name: DR. ADRIENNE BEAN
Title or Position: CO-OWNER
Credential: PSY.D
Phone: 304-365-4102