Philip E Sundstrom, M.A.,LIC PSYCHOLOGIS

NPI #1750594115 in Fayetteville, West Virginia

Provider Information

NPI Number: 1750594115
Entity Type: Individual
Name: Philip E Sundstrom, M.A.,LIC PSYCHOLOGIS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist
Credential: M.A.,LIC PSYCHOLOGIS
Enumeration Date: May 8, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 209 W MAPLE AVE
City: Fayetteville
State: West Virginia
ZIP Code: 25840-1413
Phone: (304) 574-2100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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