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General NPI Number Information
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NPI Number | 1730574013
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Entity Type | Organization
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Legal Business Name | ADULT AND YOUTH SERVICES, P.L.L.C.
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 1200 HARRISON AVE. SUITE 121
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City | ELKINS
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State | WV
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Zip | 26241-3392
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Country | US
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Telephone | 304-636-4200
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Fax | 304-636-4200
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Provider Business Mailing Address
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Address Line | PO BOX 44
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City | DAVIS
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State | WV
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Zip | 26260-0044
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Country | US
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Telephone | 304-257-8232
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Fax | 304-636-4200
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. DANA A NUGENT
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Credential | ED. D.
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Telephone | 304-257-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 999
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2304-8074
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License Number State | WV
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