Soulmosaic, Pllc | |
240 Scott Ave Ste 4 Morgantown WV 26508-8805 | |
(304) 685-8967 | |
Not Available |
Full Name | Soulmosaic, Pllc |
---|---|
Speciality | Counselor |
Location | 240 Scott Ave Ste 4, Morgantown, West Virginia |
Authorized Official Name and Position | Jessica Nicole Matala (OWNER) |
Authorized Official Contact | 3046858967 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Soulmosaic, Pllc 509 Lake St Morgantown WV 26505-3312 Ph: () - | Soulmosaic, Pllc 240 Scott Ave Ste 4 Morgantown WV 26508-8805 Ph: (304) 685-8967 |
NPI Number | 1013581404 |
---|---|
Provider Enumeration Date | 05/19/2021 |
Last Update Date | 05/19/2021 |
Certification Date | 05/19/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013581404 | NPI | - | NPPES |
DP00944408 | Other | WV | LISCW |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Primary |
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