Provider Demographics
NPI:1124358981
Name:KINCAID, MARLAINA
Entity Type:Individual
Prefix:MS
First Name:MARLAINA
Middle Name:
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLAINA
Other - Middle Name:
Other - Last Name:DELIONBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4255 CAVE MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3148
Mailing Address - Country:US
Mailing Address - Phone:865-659-8926
Mailing Address - Fax:865-687-1190
Practice Address - Street 1:3105 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2409
Practice Address - Country:US
Practice Address - Phone:865-687-8990
Practice Address - Fax:865-687-1190
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional