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General NPI Number Information
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NPI Number | 1518287051
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER CASE MANAGEMENT
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 1445 PARK SIDE EST
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City | FAIRMONT
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State | WV
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Zip | 26554-6109
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Country | US
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Telephone | 304-476-6698
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 PARK SIDE EST
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City | FAIRMONT
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State | WV
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Zip | 26554-6109
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Country | US
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Telephone | 304-476-6698
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM B DICKEY
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Credential | MSCRCLPC
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Telephone | 304-476-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 10211817
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License Number State | WV
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