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Certified Provider Details:
| PROVIDER NUMBER: | 490107 |
| AGENCY NAME: | Volunteer West Virginia |
| CONTACT NAME: | Kimberly Barber Tieman |
| ADDRESS: | 710 Central Avenue |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25302 |
| PHONE: | (304) 558-0111 |
| WEB SITE: | www.volunteerwv.org |
| EMAIL ADDRESS: | kim.b.tieman@wv.org |
| BSW/MSW NAME: | Kimberly Barber Tieman |
| DUE TO RECERTIFY DATE: | 7/1/2011 |
| COMMENTS: |