Provider Demographics
NPI:1548780976
Name:A BALANCED PLATE, LLC
Entity Type:Organization
Organization Name:A BALANCED PLATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:304-288-0136
Mailing Address - Street 1:4813 OLD ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525-5313
Mailing Address - Country:US
Mailing Address - Phone:304-288-0136
Mailing Address - Fax:
Practice Address - Street 1:4813 OLD ROUTE 73
Practice Address - Street 2:
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525-5313
Practice Address - Country:US
Practice Address - Phone:304-288-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty