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General NPI Number Information
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NPI Number | 1003588633
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Entity Type | Organization
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Legal Business Name | PATCHWORK THERAPY AND GROWTH CENTER, LLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 08/13/2022
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Provider Practice Location Address
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Address Line | 4766 US ROUTE 60 UNIT B
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City | HUNTINGTON
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State | WV
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Zip | 25705-1940
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Country | US
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Telephone | 304-802-4769
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Fax | 304-318-7183
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Provider Business Mailing Address
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Address Line | PO BOX 485
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City | WAYNE
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State | WV
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Zip | 25570-0485
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Country | US
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Telephone | 304-802-4769
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Fax | 304-318-7183
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA KIRK-MCCOMAS
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Credential | MSW, LICSW
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Telephone | 304-802-4769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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