Basic Information
| Provider Information | |||||||||
| NPI: | 1679920839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | EFFIE | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 1/2 KELLY DR | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260031614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043126157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 HALLORAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | ST CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402965743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2016 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.0027449 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.