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General NPI Number Information
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NPI Number | 1447534789
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Entity Type | Individual
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Provider Name | HOLLY KELLY COVILLE M.A., ED.S.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 4453 NATIONAL RD
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City | TRIADELPHIA
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State | WV
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Zip | 26059-2012
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Country | US
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Telephone | 304-909-0185
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Fax | 304-909-0188
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Provider Business Mailing Address
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Address Line | 120 BROWNS RUN RD
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City | WHEELING
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State | WV
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Zip | 26003-9459
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Country | US
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Telephone | 304-909-0185
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Fax | 304-909-0188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 880
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License Number State | WV
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