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Certified Provider Details:
| PROVIDER NUMBER: | 490089 |
| AGENCY NAME: | Office of Maternal, Child & Family Health |
| CONTACT NAME: | Patricia Moss |
| ADDRESS: | 350 Capitol Street, Room 427 |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25301 |
| PHONE: | (304) 558-7192 |
| WEB SITE: | |
| EMAIL ADDRESS: | crisvanhoff@wvdhhr.org |
| BSW/MSW NAME: | Patricia Moss |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |