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General NPI Number Information
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NPI Number | 1336023712
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Entity Type | Organization
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Legal Business Name | LAURENS WISH ADDICTION TRIAGE CENTER INC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 20 SCOTT AVE STE 301
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City | MORGANTOWN
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State | WV
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Zip | 26508-8857
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Country | US
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Telephone | 304-241-4000
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Fax | 304-212-5141
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Provider Business Mailing Address
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Address Line | 20 SCOTT AVE STE 301
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City | MORGANTOWN
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State | WV
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Zip | 26508-8857
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Country | US
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Telephone | 304-241-4000
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Fax | 304-212-5141
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. BRANDON M WISE
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Credential |
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Telephone | 304-282-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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