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General NPI Number Information
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NPI Number | 1932288107
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Entity Type | Organization
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Legal Business Name | 7TH AVE CLINIC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 623 TEMPLE ST
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City | HINTON
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State | WV
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Zip | 25951
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Country | US
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Telephone | 304-673-1913
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Fax |
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Provider Business Mailing Address
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Address Line | HC 74 BOX 284
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City | HINTON
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State | WV
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Zip | 25951-9121
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Country | US
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Telephone | 394-673-1913
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Fax | 304-466-1676
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Authorized Official
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Title or Position | OWNER
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Name | LYNN M SANDERS
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Credential | MA
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Telephone | 304-673-1913
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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 | 889
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License Number State | WV
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