Doctor Name: | MS. PAULETTE SUSAN JUSTICE |
NPI Number: | 1003987199 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, LCSW |
License Number: | 194 |
Business Practice Address: | 4825 Maccorkle Ave Sw South Charleston, WV - 253091365 |
Business Phone Number: | 3047664572 |
Business Fax Number: | 3047664599 |
Mailing Address: | 3800 Noyes Ave, CHARLESTON |
State: | WV |
Postal Code: | 253041518 |
Phone Number: | 3047664572 |
Fax Number: | 3047664599 |
NPI Enumeration Date: | 11/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 194 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |