Provider Demographics
NPI:1821246950
Name:MARNIC, LINDA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ROSE
Last Name:MARNIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385
Mailing Address - Country:US
Mailing Address - Phone:304-745-5065
Mailing Address - Fax:304-745-5067
Practice Address - Street 1:107 SOUTH STREET CAR WAY
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385
Practice Address - Country:US
Practice Address - Phone:304-745-5065
Practice Address - Fax:304-745-5067
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1072103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling