Healthcare Provider Details

I. General information

NPI: 1972204865
Provider Name (Legal Business Name): BRITTANY CYRUS-HOLLINGSWORTH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENTON DR STE 3
CHARLESTON WV
25311-1266
US

IV. Provider business mailing address

PO BOX 128
POCA WV
25159-0128
US

V. Phone/Fax

Practice location:
  • Phone: 304-941-6256
  • Fax:
Mailing address:
  • Phone: 304-769-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1330
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: