Healthcare Provider Details

I. General information

NPI: 1093711251
Provider Name (Legal Business Name): RICHARD L WORKMAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GLASS DR
CROSS LANES WV
25313-1319
US

IV. Provider business mailing address

1049 LAKEVIEW DR
CROSS LANES WV
25313-1481
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-7230
  • Fax: 304-776-7247
Mailing address:
  • Phone: 304-776-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number287
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: