Provider Demographics
NPI:1568296051
Name:PREMIA CENTER FOR EVIDENCE BASED TREATMENT PLLC
Entity type:Organization
Organization Name:PREMIA CENTER FOR EVIDENCE BASED TREATMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOLZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:304-413-6449
Mailing Address - Street 1:1405 EARL L CORE RD PMB1126
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-413-6449
Mailing Address - Fax:
Practice Address - Street 1:235 HIGH ST STE 817
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5448
Practice Address - Country:US
Practice Address - Phone:304-413-6449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty