Provider Demographics
NPI:1609053966
Name:WISDOMSOURCES PLLC
Entity Type:Organization
Organization Name:WISDOMSOURCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE SANDEL
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:304-777-4848
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty