Healthcare Provider Details

I. General information

NPI: 1578626081
Provider Name (Legal Business Name): WVVDHHR DIV. SURVEILLANCE & DISEASE CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CAPITOL ST ROOM 125
CHARLESTON WV
25301-1757
US

IV. Provider business mailing address

350 CAPITOL ST ROOM 125
CHARLESTON WV
25301-1757
US

V. Phone/Fax

Practice location:
  • Phone: 304-558-5358
  • Fax: 304-558-6335
Mailing address:
  • Phone: 304-558-5358
  • Fax: 304-558-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberNOT REQUIRED
License Number StateWV

VIII. Authorized Official

Name: MS. LORETTA E. HADDY
Title or Position: DIVISION DIRECTYOR
Credential: PHD
Phone: 404-558-5358