Healthcare Provider Details

I. General information

NPI: 1467600593
Provider Name (Legal Business Name): DARVA VICKI KINLICHEENIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 TROY KING ROAD #444
FARMINGTON NM
87401-1319
US

IV. Provider business mailing address

PO BOX 1319
SHIPROCK NM
87420-1319
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-5163
  • Fax: 505-368-5502
Mailing address:
  • Phone: 505-368-5163
  • Fax: 505-368-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-06203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: