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General NPI Number Information
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NPI Number | 1316468663
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Entity Type | Organization
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Legal Business Name | WW BEHAVIOR CONSULTING
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 76 CHAMPAGNE DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-5223
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Country | US
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Telephone | 304-692-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 76 CHAMPAGNE DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-5223
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Country | US
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Telephone | 304-692-1820
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. REGINNA LEIGH WAGONER
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Credential | BCBA
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Telephone | 304-692-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-10533
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License Number State |
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