Healthcare Provider Details

I. General information

NPI: 1356852420
Provider Name (Legal Business Name): NICOLE STINESPRING SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S QUEEN ST BERKELEY BOE
MARTINSBURG WV
25401-3233
US

IV. Provider business mailing address

401 S QUEEN ST
MARTINSBURG WV
25401-3233
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 304-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 304-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberN4L141300245
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: