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General NPI Number Information
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NPI Number | 1326727694
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Entity Type | Organization
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Legal Business Name | WILDFLOWER THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1253 CANYON RD STE 9
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City | MORGANTOWN
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State | WV
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Zip | 26508-9273
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Country | US
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Telephone | 304-449-4926
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Fax |
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Provider Business Mailing Address
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Address Line | 1253 CANYON RD STE 9
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City | MORGANTOWN
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State | WV
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Zip | 26508-9273
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Country | US
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Telephone | 304-449-4926
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA AIGNER
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Credential | LICSW
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Telephone | 304-449-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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