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General NPI Number Information
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NPI Number | 1578786174
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Entity Type | Organization
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Legal Business Name | PSYSCAPE PLLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 201 6TH AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2836
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Country | US
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Telephone | 304-552-9832
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Fax | 866-212-0708
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Provider Business Mailing Address
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Address Line | 447 POPLAR FORK RD
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City | SCOTT DEPOT
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State | WV
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Zip | 25560-9788
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Country | US
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Telephone | 304-552-9832
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Fax | 866-212-0708
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MR. ERNIE L. VECCHIO
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Credential | MA
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Telephone | 304-552-9832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 647
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License Number State | WV
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