Healthcare Provider Details

I. General information

NPI: 1073563185
Provider Name (Legal Business Name): CHRISTINA M ARCO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013B OAKHURST DR
CHARLESTON WV
25314-2049
US

IV. Provider business mailing address

PO BOX 3912
CHARLESTON WV
25339-3912
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-7591
  • Fax: 304-720-7593
Mailing address:
  • Phone: 304-720-7591
  • Fax: 304-720-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number311
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: