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General NPI Number Information
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NPI Number | 1043263635
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Entity Type | Organization
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Legal Business Name | LINDA S GERONILLA PHD INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 92 COOK DR
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City | CHARLESTON
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State | WV
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Zip | 25314-1003
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Country | US
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Telephone | 304-342-2260
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Fax | 304-344-4522
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Provider Business Mailing Address
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Address Line | 92 COOK DR
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City | CHARLESTON
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State | WV
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Zip | 25314-1003
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Country | US
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Telephone | 304-342-2260
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Fax | 304-344-4522
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINDA S. GERONILLA
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Credential | PH.D.
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Telephone | 304-342-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 385
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License Number State | WV
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