Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 757 | WV |
Y | 103T00000X | Psychologist | 757 | WV |
NPI | 1003915711 |
---|---|
Provider Name | Samantha Mann |
First Address | Princeton, WV 24740-7660 |
Second Address | Princeton, WV 24740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 24/11/2014 |