Healthcare Provider Details

I. General information

NPI: 1700710290
Provider Name (Legal Business Name): WEST VIRGINIA INTEGRATIVE PSYCHOLOGICAL AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BROWN AVENUE
UNEEDA WV
25205-0775
US

IV. Provider business mailing address

PO BOX 775
UNEEDA WV
25205-0775
US

V. Phone/Fax

Practice location:
  • Phone: 304-687-3606
  • Fax:
Mailing address:
  • Phone: 304-687-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MONICA BALLARD-BOOTH
Title or Position: OWNER
Credential: LP, LSW
Phone: 304-687-3606