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General NPI Number Information
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NPI Number | 1720294226
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Entity Type | Organization
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Legal Business Name | POLONCHAK EDUCATIONAL ASSOCIATES
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 129 E. GERMAN ST.
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443
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Country | US
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Telephone | 304-876-3022
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Fax | 304-876-1421
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Provider Business Mailing Address
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Address Line | 234 DEER MOUNTAIN DR
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City | HARPERS FERRY
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State | WV
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Zip | 25425-5490
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Country | US
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Telephone | 304-876-1421
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Fax | 304-876-1421
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. CATHY POLONCHAK
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Credential | LICSW
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Telephone | 304-876-1421
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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 | DP00940860
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License Number State | WV
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