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General NPI Number Information
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NPI Number | 1265307581
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Entity Type | Organization
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Legal Business Name | MPAC MENTAL HEALTH WEST VIRGINIA PLLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 302 CEDAR RIDGE RD
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City | SISSONVILLE
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State | WV
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Zip | 25320-9502
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Country | US
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Telephone | 304-984-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 W GRAND AVE STE B #28354
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City | CHICAGO
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State | IL
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Zip | 60612-1577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL WILLS
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Credential |
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Telephone | 312-447-1941
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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 |
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License Number State |
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