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Certified Provider Details:
| PROVIDER NUMBER: | 490105 |
| AGENCY NAME: | Mental Health Association Greater Kanawha Valley |
| CONTACT NAME: | Ellen Ward |
| ADDRESS: | ONE UNITED WAY SQUARE |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 253011098 |
| PHONE: | (304) 340-3512 |
| WEB SITE: | mha-kanawha.org |
| EMAIL ADDRESS: | mha@wvinter.net |
| BSW/MSW NAME: | Anna Laliotis |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |