Provider Demographics
NPI:1407168859
Name:KAY C. BALLINA (DBA) ASSOCIATES IN COUNSELING AND PSYCHOLOGY
Entity Type:Organization
Organization Name:KAY C. BALLINA (DBA) ASSOCIATES IN COUNSELING AND PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:BALLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-766-6700
Mailing Address - Street 1:4857 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1331
Mailing Address - Country:US
Mailing Address - Phone:304-744-2600
Mailing Address - Fax:304-766-6700
Practice Address - Street 1:4857 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1331
Practice Address - Country:US
Practice Address - Phone:304-766-6700
Practice Address - Fax:304-766-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1111000000Medicaid