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General NPI Number Information
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NPI Number | 1548696644
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Entity Type | Organization
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Legal Business Name | KINETIC CONNECTIONS, LLC
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 16741 SENECA TRL
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City | MARLINTON
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State | WV
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Zip | 24954-7002
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Country | US
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Telephone | 304-799-4343
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Fax | 304-799-4444
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Provider Business Mailing Address
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Address Line | PO BOX 6
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City | MARLINTON
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State | WV
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Zip | 24954-0006
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Country | US
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Telephone | 304-799-4343
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Fax | 304-799-4444
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DAVINA R AGEE
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Credential | LSW
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Telephone | 304-940-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | AP00943540
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License Number State | WV
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