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General NPI Number Information
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NPI Number | 1386025765
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Entity Type | Organization
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Legal Business Name | SUBLIME BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 124 1/2 S QUEEN ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3316
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Country | US
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Telephone | 304-579-4784
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Fax | 304-433-8359
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Provider Business Mailing Address
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Address Line | 124 1/2 S QUEEN ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3316
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Country | US
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Telephone | 304-579-4784
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Fax | 304-433-8359
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Authorized Official
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Title or Position | MANAGER
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Name | JENNIFER M. ALBRIGHT
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Credential |
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Telephone | 304-579-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 23918
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 23918
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License Number State | WV
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