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Certified Provider Details:
| PROVIDER NUMBER: | 490069 |
| AGENCY NAME: | Prestera Center |
| CONTACT NAME: | Emily Fitzwater |
| ADDRESS: | 3375 US Rt. 60 East |
| CITY: | Huntington |
| STATE: | WV |
| ZIP: | 25705 |
| PHONE: | (304) 399-1110 |
| WEB SITE: | www.prestera.org |
| EMAIL ADDRESS: | |
| BSW/MSW NAME: | Donald White, MSW, LGSW |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |