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General NPI Number Information
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NPI Number | 1376498642
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Entity Type | Organization
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Legal Business Name | WILD AND WONDERFUL BEHAVIORAL HEALTH, PLLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 56 WEST LN
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1336
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Country | US
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Telephone | 912-710-8028
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Fax |
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Provider Business Mailing Address
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Address Line | 56 WEST LN
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1336
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Country | US
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Telephone | 912-710-8028
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JESSICA NICHOLE SLASH
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Credential | LICSW
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Telephone | 912-710-8028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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