Provider Demographics
NPI:1386025765
Name:SUBLIME BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:SUBLIME BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-579-4784
Mailing Address - Street 1:124 1/2 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3316
Mailing Address - Country:US
Mailing Address - Phone:304-579-4784
Mailing Address - Fax:304-433-8359
Practice Address - Street 1:124 1/2 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3316
Practice Address - Country:US
Practice Address - Phone:304-579-4784
Practice Address - Fax:304-433-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV239182084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty