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General NPI Number Information
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NPI Number | 1053081182
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Entity Type | Organization
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Legal Business Name | WINDING WAY LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 49 PARK RIDGE DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-4032
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Country | US
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Telephone | 304-692-1131
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1330
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City | DELLSLOW
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State | WV
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Zip | 26531-1330
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Country | US
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Telephone | 304-692-1131
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Fax |
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Authorized Official
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Title or Position | SOLE MBR / LICENSED PSYCHOLOGIST
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Name | DR. TERESA B STIRE
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Credential | PH.D.
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Telephone | 304-692-1131
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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 |
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License Number State |
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