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General NPI Number Information
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NPI Number | 1619073343
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Entity Type | Organization
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Legal Business Name | MARI SULLIVAN WALKER INC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | RT#10 MAIN STREET
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City | PINEVILLE
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State | WV
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Zip | 24874-0123
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Country | US
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Telephone | 304-732-9132
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Fax | 304-732-6589
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Provider Business Mailing Address
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Address Line | RT#10 MAIN STREET P.O. BOX 123
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City | PINEVILLE
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State | WV
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Zip | 24874-0123
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Country | US
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Telephone | 304-732-9132
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Fax | 304-732-6589
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Authorized Official
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Title or Position | CEO
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Name | MS. MARI SULLIVAN WALKER
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Credential | LICENSED PSYCHOLOGIS
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Telephone | 304-732-9132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 203
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 203
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 203
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License Number State | WV
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