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General NPI Number Information
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NPI Number | 1558896993
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Entity Type | Organization
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Legal Business Name | COUNCIL OF THE SOUTHERN MOUNTAINS
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 148 MCDOWELL ST
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City | WELCH
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State | WV
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Zip | 24801-2225
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Country | US
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Telephone | 304-436-6800
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Fax | 304-436-6803
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Provider Business Mailing Address
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Address Line | 148 MCDOWELL ST
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City | WELCH
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State | WV
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Zip | 24801-2225
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Country | US
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Telephone | 304-436-6800
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Fax | 304-436-6803
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RANDAL JOHNSON
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Credential | M.A.
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Telephone | 304-436-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 384
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License Number State | WV
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