Provider Demographics
NPI:1659320141
Name:WEIR, LOLA RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOLA
Middle Name:RUTH
Last Name:WEIR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PENNSYLVANIA AVE
Mailing Address - Street 2:FAMILY RESOURCE CENTER WOMEN & CHILDRENS HOSPITAL
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-388-2545
Mailing Address - Fax:304-388-2781
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:FAMILY RESOURCE CENTER WOMEN & CHILDRENS HOSPITAL
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-388-2545
Practice Address - Fax:304-388-2781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV681103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164835000Medicaid
WVWECP77191Medicare ID - Type Unspecified