Healthcare Provider Details

I. General information

NPI: 1821246950
Provider Name (Legal Business Name): LINDA ROSE MARNIC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SOUTH STREET CAR WAY
LOST CREEK WV
26385
US

IV. Provider business mailing address

PO BOX 490
LOST CREEK WV
26385
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-5065
  • Fax: 304-745-5067
Mailing address:
  • Phone: 304-745-5065
  • Fax: 304-745-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1072
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: