Healthcare Provider Details

I. General information

NPI: 1730259946
Provider Name (Legal Business Name): AMY WILSON STRANGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SOUTH STREETCAR WAY
LOST CREEK WV
26385-0490
US

IV. Provider business mailing address

PO BOX 490 107 SOUTH STREETCAR WAY
LOST CREEK WV
26385-0490
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-5065
  • Fax: 304-745-5067
Mailing address:
  • Phone: 304-745-5065
  • Fax: 304-745-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number858
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: