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General NPI Number Information
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NPI Number | 1235354879
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Entity Type | Organization
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Legal Business Name | DAVIS-STUART, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | RR 2 BOX 188A
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City | LEWISBURG
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State | WV
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Zip | 24901-9320
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Country | US
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Telephone | 304-647-5577
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Fax | 304-647-5727
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Provider Business Mailing Address
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Address Line | RR 2 BOX 188A
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City | LEWISBURG
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State | WV
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Zip | 24901-9320
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Country | US
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Telephone | 304-647-5577
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Fax | 304-647-5727
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Authorized Official
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Title or Position | EX. DIRECTOR
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Name | MR. MARK A SPANGLER
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Credential | MA, LPC
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Telephone | 304-647-5577
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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 | 186
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License Number State | WV
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