Provider Demographics
NPI:1215230685
Name:DEPARTMENT OF VETERANS AFFAIRS VET CENTER
Entity type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS VET CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, ASW
Authorized Official - Phone:304-232-0587
Mailing Address - Street 1:1058 E BETHLEHEM BLVD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4961
Mailing Address - Country:US
Mailing Address - Phone:304-232-0587
Mailing Address - Fax:304-232-1031
Practice Address - Street 1:1058 E BETHLEHEM BLVD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4961
Practice Address - Country:US
Practice Address - Phone:304-232-0587
Practice Address - Fax:304-232-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00942969251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health