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General NPI Number Information
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NPI Number | 1043684699
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL COUNSELING THERAPIES,PLLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 118 W BURKE ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3302
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Country | US
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Telephone | 304-676-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 118 W BURKE ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3302
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Country | US
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Telephone | 304-676-2808
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MICHAEL A GRAY
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Credential | EDD
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Telephone | 304-676-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | WV1107
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License Number State | WV
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