Healthcare Provider Details

I. General information

NPI: 1326761248
Provider Name (Legal Business Name): CHRISTIANNE SHERILIN CONNELLY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 STEWARTSTOWN RD STE 200
MORGANTOWN WV
26505-3868
US

IV. Provider business mailing address

1445 STEWARTSTOWN RD STE 200
MORGANTOWN WV
26505-3868
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2300
  • Fax:
Mailing address:
  • Phone: 304-598-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1317
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1317
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: