Provider Demographics
NPI:1518221837
Name:VALLEY COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:VALLEY COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:VALLEY HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER CD OUTPATIENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:304-296-1731
Mailing Address - Street 1:301 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8804
Mailing Address - Country:US
Mailing Address - Phone:304-296-1731
Mailing Address - Fax:304-225-2288
Practice Address - Street 1:301 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8804
Practice Address - Country:US
Practice Address - Phone:304-296-1731
Practice Address - Fax:304-225-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP04535527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty