Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1239 | WV |
Y | 103T00000X | Psychologist | 1239 | WV |
NPI | 1003453440 |
---|---|
Provider Name | Holly Sly |
First Address | Beckley, WV 25801-4929 |
Second Address | Beckley, WV 25801-4929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |