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General NPI Number Information
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NPI Number | 1700710290
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Entity Type | Organization
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Legal Business Name | WEST VIRGINIA INTEGRATIVE PSYCHOLOGICAL AND WELLNESS, PLLC
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 74 BROWN AVENUE
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City | UNEEDA
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State | WV
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Zip | 25205-0775
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Country | US
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Telephone | 304-687-3606
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 775
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City | UNEEDA
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State | WV
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Zip | 25205-0775
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Country | US
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Telephone | 304-687-3606
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA BALLARD-BOOTH
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Credential | LP, LSW
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Telephone | 304-687-3606
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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 |
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License Number State |
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