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General NPI Number Information
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NPI Number | 1669538732
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Entity Type | Organization
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Legal Business Name | ETERNITY, INC
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 10/29/2011
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Provider Practice Location Address
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Address Line | 112 EUCLID AVE
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City | MORGANTOWN
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State | WV
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Zip | 26501-6584
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Country | US
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Telephone | 304-291-5964
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Fax |
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Provider Business Mailing Address
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Address Line | 112 EUCLID AVE
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City | MORGANTOWN
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State | WV
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Zip | 26501-6584
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Country | US
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Telephone | 304-291-5964
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Fax |
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Authorized Official
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Title or Position | VICEPRESIDENT, SECRETARY
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Name | DR. JANE B. RIFFE
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Credential | ED.D.
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Telephone | 304-291-5964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 529
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00454299
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License Number State | WV
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