Healthcare Provider Details

I. General information

NPI: 1285725200
Provider Name (Legal Business Name): KATHLEEN SABO VIGLIANCO L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 MAIN ST
WEIRTON WV
26062-4704
US

IV. Provider business mailing address

3366 MAIN ST
WEIRTON WV
26062-4704
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-8343
  • Fax: 304-797-8323
Mailing address:
  • Phone: 304-797-8343
  • Fax: 304-797-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number205
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: