Provider Demographics
NPI:1255477899
Name:PETTIT, LINDA MARIE SANDEL (EDD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE SANDEL
Last Name:PETTIT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525-0100
Mailing Address - Country:US
Mailing Address - Phone:304-692-4868
Mailing Address - Fax:304-777-4849
Practice Address - Street 1:1445 STEWARTSTOWN RD STE 150
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2949
Practice Address - Country:US
Practice Address - Phone:304-777-4848
Practice Address - Fax:304-777-4849
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist