Basic Information
| Provider Information | |||||||||
| NPI: | 1972571537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | NEW RIVER HEALTH ASSOCIATION INC | ||||||||
| City: | SCARBRO | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044651378 | ||||||||
| FaxNumber: | 3044692981 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 SUTPHIN LN | ||||||||
| Address2: | NEW RIVER HEALTH SBH | ||||||||
| City: | SCARBRO | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259178817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044651378 | ||||||||
| FaxNumber: | 3044692981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | DP00138850 | WV | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 3810004472 | 05 | WV | MEDICAID |