Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 311 | WV |
NPI | 1073563185 |
---|---|
Provider Name | Mrs. Christina M Arco |
First Address | Charleston, WV 25339-3912 |
Second Address | Charleston, WV 25314-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810003754 | (05) | WV |