Healthcare Provider Details

I. General information

NPI: 1427476738
Provider Name (Legal Business Name): CLAY COUNTY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MAIN ST
CLAY WV
25043
US

IV. Provider business mailing address

PO BOX 455
CLAY WV
25043-0455
US

V. Phone/Fax

Practice location:
  • Phone: 304-587-4251
  • Fax: 304-587-2787
Mailing address:
  • Phone: 304-587-4251
  • Fax: 304-587-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1035-0894
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1035-0894
License Number StateWV

VIII. Authorized Official

Name: PAMELA J TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-587-4251