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General NPI Number Information
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NPI Number | 1639665912
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Entity Type | Organization
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Legal Business Name | DAMOUS CENTER
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 234 LEE AVE
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City | NITRO
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State | WV
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Zip | 25143
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Country | US
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Telephone | 304-201-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 218 D ST
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-3104
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Country | US
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Telephone | 304-720-3835
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Fax | 304-720-3836
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE MICHAEL DAMOUS
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Credential | MA
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Telephone | 304-720-3835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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