MEDICARE: WV INSTITUTE FOR SPIRITULIATY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1228	WV

General Provider Information

NPI Number	:	1821458928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WV INSTITUTE FOR SPIRITULIATY

Provider Business Mailing Address
First Line	:	1601 VIRGINIA ST E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2113
Country	:	US
Telephone Number	:	304-345-0926
Fax Number	:	304-345-8206

Provider Business Practice Location Address
First Line	:	1601 VIRGINIA ST E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2113
Country	:	US
Telephone Number	:	304-345-0926
Fax Number	:	304-345-8206

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. CAROLE ANNE RILEY
Credential	:	LPC
Telephone Number	:	412-901-4259

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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