Organization Name: | JEFFERSON DAY REPORT CENTER, INC. |
NPI Number: | 1790130508 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONDA S EDDY (DIRECTOR) |
Mailing Address: | 121 W. Third Avenue Ranson |
State: | WV US |
Postal Code: | 25425 |
Phone Number: | 3047283527 |
Fax Number: | 3047283614 |
NPI Enumeration Date: | 04/29/2016 |
NPI Last Update Date: | 04/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 521 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |