Provider Demographics
NPI:1073520771
Name:CANTERBURY, NANCY RABEL (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RABEL
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1215
Mailing Address - Country:US
Mailing Address - Phone:304-346-6161
Mailing Address - Fax:304-346-6166
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1215
Practice Address - Country:US
Practice Address - Phone:304-346-6161
Practice Address - Fax:304-346-6166
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV275103TC0700X
WV22019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0165269000Medicaid
CA060761Medicare ID - Type Unspecified