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General NPI Number Information
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NPI Number | 1245305028
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Entity Type | Individual
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Provider Name | PHYLLIS G HASTY MSW
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1705 JEFFERSON ST SUITE 2
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City | BLUEFIELD
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State | WV
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Zip | 24701-4013
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Country | US
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Telephone | 304-327-5331
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Fax | 304-327-5336
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | BLUEFIELD
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State | WV
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Zip | 24701-0902
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Country | US
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Telephone | 304-327-5331
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Fax | 304-327-5336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00939488
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License Number State | WV
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