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Certified Provider Details:
| PROVIDER NUMBER: | 490050 |
| AGENCY NAME: | WV State University Social Work Dept. |
| CONTACT NAME: | Rita Brown |
| ADDRESS: | P O Box 1000 - Campus Box 154 |
| CITY: | Institute |
| STATE: | WV |
| ZIP: | 25112 |
| PHONE: | |
| WEB SITE: | |
| EMAIL ADDRESS: | brownri@wvstateu.edu |
| BSW/MSW NAME: | Rita Brown |
| DUE TO RECERTIFY DATE: | 7/1/2020 |
| COMMENTS: |