=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851328116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA H MCCALL LSW, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PEYTON WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-720-8466
-----------------------------------------------------
Fax | 304-720-8463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7310
-----------------------------------------------------
City | CROSS LANES
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25356-0310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-776-7606
-----------------------------------------------------
Fax | 304-776-7636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 412
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------