Individual
KELLY MARIE RUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
950 N 4TH ST, LONGVIEW, TX 75601-5436
(903) 758-2471
(903) 234-1639
Mailing address
107 WOODBINE PL, LONGVIEW, TX 75601-2912
(903) 758-2471
(903) 234-1639
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14164
TX
Other
Enumeration date
06/07/2021
Last updated
06/07/2021
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