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Certified Provider Details:
| PROVIDER NUMBER: | 490097 |
| AGENCY NAME: | WV Prevention Resource Center |
| CONTACT NAME: | Judy Hall |
| ADDRESS: | 100 Angus E. Peyton Drive |
| CITY: | South Charleston |
| STATE: | WV |
| ZIP: | 25303 |
| PHONE: | (304) 766-6301 ext. 15 |
| WEB SITE: | www.prevnet.org |
| EMAIL ADDRESS: | judy.hall@marshall.edu |
| BSW/MSW NAME: | Deborah Gillespie |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |