Healthcare Provider Details

I. General information

NPI: 1326009580
Provider Name (Legal Business Name): EASTERN PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 N HIGH ST SUITE 1
ROMNEY WV
26757-1415
US

IV. Provider business mailing address

278 N HIGH ST P.O. BOX 1830
ROMNEY WV
26757-1415
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-3429
  • Fax: 304-822-7225
Mailing address:
  • Phone: 304-822-3429
  • Fax: 304-822-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number713
License Number StateWV

VIII. Authorized Official

Name: MRS. SHERI ELLEN COLEMAN
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: M.A.
Phone: 304-822-3429