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General NPI Number Information
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NPI Number | 1912392838
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Entity Type | Organization
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Legal Business Name | CHIRON PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1907 CONSTITUTION DR
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City | FAIRMONT
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State | WV
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Zip | 26554-8527
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Country | US
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Telephone | 304-669-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 CONSTITUTION DR
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City | FAIRMONT
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State | WV
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Zip | 26554-8527
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Country | US
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Telephone | 304-669-6408
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | HALLIE A MCLEOD
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Credential | M.A.
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Telephone | 304-669-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 756
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License Number State | WV
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