Provider Demographics
NPI:1609921261
Name:PRIMARY PSYCHOLOGICAL CARE PLLC
Entity Type:Organization
Organization Name:PRIMARY PSYCHOLOGICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:304-530-6748
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:304-530-6748
Mailing Address - Fax:304-530-3737
Practice Address - Street 1:216 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-530-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV234103TC0700X
WV478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710748OtherBCBS
WV3810006083Medicaid
WV3810006083Medicaid