Provider Demographics
NPI:1902049828
Name:NANCY RABEL CANTERBURY, M.A., INC.
Entity Type:Organization
Organization Name:NANCY RABEL CANTERBURY, M.A., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-346-6161
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-346-6161
Mailing Address - Fax:304-346-6166
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-346-6161
Practice Address - Fax:304-346-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0165269000Medicaid
WV0607061Medicare PIN