Provider Demographics
NPI:1851630073
Name:LAND, PATIENCE RENEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PATIENCE
Middle Name:RENEE
Last Name:LAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 567
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9583
Mailing Address - Country:US
Mailing Address - Phone:800-733-0512
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 567
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9583
Practice Address - Country:US
Practice Address - Phone:800-733-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00942744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health