=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902049828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY RABEL CANTERBURY, M.A., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2009
-----------------------------------------------------
Last Update Date | 04/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 MACCORKLE AVE SE SUITE 401
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25304-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-346-6161
-----------------------------------------------------
Fax | 304-346-6166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 MACCORKLE AVE SE SUITE 401
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25304-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-346-6161
-----------------------------------------------------
Fax | 304-346-6166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | NANCY CANTERBURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-346-6161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 275
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------