Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | M2L134900278 | WV |
NPI | 1043619687 |
---|---|
Provider Name | Mollie M O'rourke |
First Address | Clarksburg, WV 26301-1989 |
Second Address | Morgantown, WV 26501-7546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |