Healthcare Provider Details

I. General information

NPI: 1043263635
Provider Name (Legal Business Name): LINDA S GERONILLA PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 COOK DR
CHARLESTON WV
25314-1003
US

IV. Provider business mailing address

92 COOK DR
CHARLESTON WV
25314-1003
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-2260
  • Fax: 304-344-4522
Mailing address:
  • Phone: 304-342-2260
  • Fax: 304-344-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number385
License Number StateWV

VIII. Authorized Official

Name: DR. LINDA S. GERONILLA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 304-342-2260