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General NPI Number Information
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NPI Number | 1689288813
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Entity Type | Organization
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Legal Business Name | LILYS PLACE FAMILY CENTER
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 1235 6TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2904
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Country | US
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Telephone | 304-523-5459
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Fax | 304-523-8341
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | HUNTINGTON
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State | WV
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Zip | 25706
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Country | US
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Telephone | 304-523-5459
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Fax | 304-523-8341
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. REBECCA DAWN CROWDER
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Credential | MASTER OF ED
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Telephone | 304-523-5459
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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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