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General NPI Number Information
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NPI Number | 1710481916
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Entity Type | Individual
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Provider Name | MEGHAN NICOLE BOARD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 505 LEON SULLIVAN WAY
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City | CHARLESTON
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State | WV
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Zip | 25301-1216
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Country | US
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Telephone | 304-419-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 105 MATHEWS RD
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City | RED HOUSE
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State | WV
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Zip | 25168-7656
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Country | US
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Telephone | 304-419-2241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0900103-SUPV
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License Number State | OH
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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 | DP00944749
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License Number State | WV
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