Healthcare Provider Details

I. General information

NPI: 1124555230
Provider Name (Legal Business Name): WILLIAM RAYMOND THOMPSON RECOVERY COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SUMMERLEE AVE
OAK HILL WV
25901-3059
US

IV. Provider business mailing address

114 SUMMERLEE AVE
OAK HILL WV
25901-3059
US

V. Phone/Fax

Practice location:
  • Phone: 304-877-1074
  • Fax:
Mailing address:
  • Phone: 304-877-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: