Provider Demographics
NPI:1376637397
Name:SOTAK, NANCY E (MA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:SOTAK
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:PO BOX 1128
Mailing Address - Street 2:1014 JOHNSTOWN ROAD
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1128
Mailing Address - Country:US
Mailing Address - Phone:304-252-4433
Mailing Address - Fax:304-252-1703
Practice Address - Street 1:1014 JOHNSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4940
Practice Address - Country:US
Practice Address - Phone:304-252-4433
Practice Address - Fax:304-252-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0116820000Medicaid
WV3810004530Medicaid
WV3810004530Medicaid
WVFA0504794Medicare ID - Type Unspecified