Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 1202 | WV |
NPI | 1174666879 |
---|---|
Provider Name | Perry Lee Cain |
First Address | Clarksburg, WV 26302-1676 |
Second Address | Clarksburg, WV 26301-2711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |