Healthcare Provider Details

I. General information

NPI: 1487725834
Provider Name (Legal Business Name): SCOTT ANDREW SPAULDING MA PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SMITH ST SUITE 207
CHARLESTON WV
25301-1314
US

IV. Provider business mailing address

1116 SMITH ST SUITE 207
CHARLESTON WV
25301-1314
US

V. Phone/Fax

Practice location:
  • Phone: 888-505-1862
  • Fax: 681-265-9250
Mailing address:
  • Phone: 888-505-1862
  • Fax: 681-265-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberWV936
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberWV936
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberWV936
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: