Provider Demographics
NPI:1518286566
Name:4 A KINDER CLASS
Entity Type:Organization
Organization Name:4 A KINDER CLASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:410-842-3978
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-0037
Mailing Address - Country:US
Mailing Address - Phone:410-842-3978
Mailing Address - Fax:804-883-5556
Practice Address - Street 1:13492 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2622
Practice Address - Country:US
Practice Address - Phone:410-842-3978
Practice Address - Fax:804-883-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004671101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty