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General NPI Number Information
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NPI Number | 1578626081
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Entity Type | Organization
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Legal Business Name | WVVDHHR DIV. SURVEILLANCE & DISEASE CONTROL
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 350 CAPITOL ST ROOM 125
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City | CHARLESTON
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State | WV
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Zip | 25301-1757
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Country | US
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Telephone | 304-558-5358
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Fax | 304-558-6335
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Provider Business Mailing Address
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Address Line | 350 CAPITOL ST ROOM 125
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City | CHARLESTON
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State | WV
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Zip | 25301-1757
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Country | US
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Telephone | 304-558-5358
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Fax | 304-558-6335
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Authorized Official
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Title or Position | DIVISION DIRECTYOR
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Name | MS. LORETTA E. HADDY
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Credential | PHD
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Telephone | 404-558-5358
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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 | NOT REQUIRED
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License Number State | WV
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