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General NPI Number Information
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NPI Number | 1356475412
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT AND INTERVENTION SERVICES, LLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 1 DUNBAR PLZ STE 100A
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City | DUNBAR
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State | WV
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Zip | 25064-3038
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Country | US
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Telephone | 304-346-9586
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Fax | 304-344-2169
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Provider Business Mailing Address
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Address Line | 10304 SPOTSYLVANIA AVE STE 300
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8605
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Country | US
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Telephone | 304-346-9586
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Fax | 304-344-2169
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Authorized Official
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Title or Position | WV DIRECTOR OF OPERATIONS
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Name | LAURA MARIE WHITE
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Credential |
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Telephone | 304-992-6153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 566
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License Number State | WV
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