Healthcare Provider Details

I. General information

NPI: 1295869840
Provider Name (Legal Business Name): PSYCHOLOGICAL CONSULTATION AND ASSESSMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
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

202 GLASS DR
CROSS LANES WV
25313-1319
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD WORKMAN
Title or Position: OWNER PRESIDENT PSYCHOLOGIST
Credential: MA
Phone: 304-776-7230