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General NPI Number Information
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NPI Number | 1316598543
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Entity Type | Individual
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Provider Name | MEGHAN DAWN LIVELY LGSW
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Gender | Female
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 09/29/2019
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Provider Practice Location Address
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Address Line | 102 PATRICK STREET PLZ
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City | CHARLESTON
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State | WV
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Zip | 25387-2444
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Country | US
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Telephone | 304-233-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3 LOWER FALLS ESTS
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City | SAINT ALBANS
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State | WV
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Zip | 25177-9537
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Country | US
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Telephone | 304-881-3071
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00945551
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License Number State | WV
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