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General NPI Number Information
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NPI Number | 1457068827
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Entity Type | Individual
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Provider Name | TERESA LYNN BRANNON WVCPRSS, DIRECTOR
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Gender | Female
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 1206 QUARRIER ST
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City | CHARLESTON
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State | WV
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Zip | 25301-1843
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Country | US
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Telephone | 681-710-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 6TH ST
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City | CHARLESTON
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State | WV
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Zip | 25302-1413
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Country | US
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Telephone | 681-319-6631
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 22-992
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License Number State | WV
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