Healthcare Provider Details

I. General information

NPI: 1376810432
Provider Name (Legal Business Name): WILLIAM EDWARD LANHAM JR. L.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WABASH AVE
PHILIPPI WV
26416-1262
US

IV. Provider business mailing address

23 WABASH AVE
PHILIPPI WV
26416-1262
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-1670
  • Fax: 304-457-1296
Mailing address:
  • Phone: 304-457-1670
  • Fax: 304-457-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00941330
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: