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General NPI Number Information
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NPI Number | 1639855885
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Entity Type | Organization
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Legal Business Name | THE DEVELOPMENTAL ADVANTAGE, LLC
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 888 OAKWOOD RD STE 300
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City | CHARLESTON
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State | WV
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Zip | 25314-2071
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Country | US
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Telephone | 304-881-2585
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Fax | 681-217-1593
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Provider Business Mailing Address
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Address Line | 12 KILLEN HOLLOW DR
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City | CROSS LANES
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State | WV
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Zip | 25313-3516
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Country | US
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Telephone | 304-881-2585
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Fax | 681-217-1593
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CATHY JO HIGGINS
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Credential |
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Telephone | 304-881-2585
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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 |
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License Number State |
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