Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 631 | WV |
N | 103G00000X | Clinical Psychologist | 631 | WV |
N | 103TC0700X | Clinical Psychologist | 631 | WV |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 631 | WV |
NPI | 1053419945 |
---|---|
Provider Name | Mrs. Cynthia Lorraine Clay |
First Address | Huntington, WV 25701-2238 |
Second Address | Huntington, WV 25701-2238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1064305000 | (05) | WV |