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General NPI Number Information
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NPI Number | 1114248861
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES OF KYOWVA AREA, INC. FAMILY SERVICE DIVISION
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 1102 MEMORIAL BLVD. W
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City | HUNTINGTON
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State | WV
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Zip | 25701
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Country | US
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Telephone | 304-523-9545
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Fax | 304-525-7038
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Provider Business Mailing Address
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Address Line | 1102 MEMORIAL BLVD. W.
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City | HUNTINGTON
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State | WV
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Zip | 25701
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Country | US
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Telephone | 304-523-9545
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Fax | 304-525-7038
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ALISSA STEWART
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Credential |
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Telephone | 304-523-9454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WV
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