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General NPI Number Information
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NPI Number | 1689860926
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Entity Type | Organization
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Legal Business Name | KIDS INC.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 3063 ORDWAY DR NW APT H
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City | ROANOKE
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State | VA
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Zip | 24017-1977
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Country | US
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Telephone | 540-362-1526
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Fax |
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Provider Business Mailing Address
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Address Line | 3063 ORDWAY DR NW APT H
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City | ROANOKE
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State | VA
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Zip | 24017-1977
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Country | US
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Telephone | 540-362-1526
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. MARY CHARLES MCNEIL
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Credential | LCSW
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Telephone | 540-362-1529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003211
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License Number State | VA
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