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General NPI Number Information
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NPI Number | 1790130508
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Entity Type | Organization
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Legal Business Name | JEFFERSON DAY REPORT CENTER, INC.
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 130 E BURR BLVD FL 1
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City | KEARNEYSVILLE
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State | WV
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Zip | 25430-4788
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Country | US
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Telephone | 304-728-3527
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Fax | 304-728-3614
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Provider Business Mailing Address
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Address Line | 130 E BURR BLVD FL 1
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City | KEARNEYSVILLE
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State | WV
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Zip | 25430-4788
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Country | US
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Telephone | 304-728-3527
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Fax | 304-728-3614
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Authorized Official
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Title or Position | DIRECTOR
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Name | KELLY FRANKLIN
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Credential |
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Telephone | 304-728-3257
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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 |
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 521
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License Number State | WV
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