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Certified Provider Details:
| PROVIDER NUMBER: | 490096 |
| AGENCY NAME: | WV Institute for Spirituality |
| CONTACT NAME: | Dr. Carole Riley |
| ADDRESS: | 1601 Virginia Street, East |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25311 |
| PHONE: | (304) 345-0926 |
| WEB SITE: | www.wvinstituteforspirituality.org |
| EMAIL ADDRESS: | wviscr@aol.com |
| BSW/MSW NAME: | Elizabeth Kent |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |