Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | CP00943189 | WV |
NPI | 1003580473 |
---|---|
Provider Name | Laura Wilson |
First Address | Keyser, WV 26726-8215 |
Second Address | Burlington, WV 26710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2021 |
Last Update Date | 09/08/2021 |