Healthcare Provider Details

I. General information

NPI: 1619040805
Provider Name (Legal Business Name): MORGANTOWN PASTORAL COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 MAPLE DR STE 1
MORGANTOWN WV
26505-2815
US

IV. Provider business mailing address

1062 MAPLE DR SUITE1
MORGANTOWN WV
26505-0809
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5751
  • Fax: 304-599-2124
Mailing address:
  • Phone: 304-599-5751
  • Fax: 304-599-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE DAVID MOSES
Title or Position: DIRECTOR
Credential: ED.D.
Phone: 304-599-5751