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General NPI Number Information
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NPI Number | 1154780294
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Entity Type | Organization
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Legal Business Name | GREENBRIER ACADEMY FOR GIRLS
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 158 ACADEMY DR. GREENBRIER ACADEMY FOR GIRLS
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City | PENCE SPRINGS
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State | WV
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Zip | 24962
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Country | US
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Telephone | 877-788-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 158 ACADEMY DR. GREENBRIER ACADEMY FOR GIRLS
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City | PENCE SPRINGS
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State | WV
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Zip | 24962
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Country | US
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Telephone | 877-788-8422
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Fax |
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Authorized Official
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Title or Position | COUNSELOR SUPERVISOR
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Name | GINGER CONLEY
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Credential | LPC
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Telephone | 877-788-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 270
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License Number State | WV
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