Individual provider · Type 1 NPI

Kelly Marie Runk, LCDC

Addiction (Substance Use Disorder) Counselor · Longview, TX

NPI number 1215504584 Active

Practice location

950 N 4th St
Longview, TX 75601-5436

Call (903) 758-2471 Map

Fax (903) 234-1639

Mailing address

107 Woodbine Pl
Longview, TX 75601-2912

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X14164 (TX)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1215504584

Kelly Marie Runk, LCDC's National Provider Identifier is 1215504584, issued on Jun 7, 2021. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Longview, TX. The record was last updated on Jun 7, 2021.