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General NPI Number Information
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NPI Number | 1558285916
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Entity Type | Organization
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Legal Business Name | KINETIC BALANCE COLLECTIVE
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 3201 FLUVIAL LN APT 406
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City | LAUREL
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State | MD
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Zip | 20724-1396
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Country | US
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Telephone | 443-455-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 FLUVIAL LN APT 406
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City | LAUREL
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State | MD
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Zip | 20724-1396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND LCPC
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Name | KASSANDRA IRENE BUTLER
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Credential |
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Telephone | 407-492-3450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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