Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 21011 | WV |
NPI | 1003916073 |
---|---|
Provider Name | Dr. Ardyce M Morgan |
First Address | Bridgeport, WV 26330-9364 |
Second Address | Weston, WV 26452-2099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0164067000 | (05) | WV |