Provider Demographics
NPI:1801347513
Name:KID KONCEPTS,LLC
Entity type:Organization
Organization Name:KID KONCEPTS,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-346-7243
Mailing Address - Street 1:2861 S F T VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ETLAN
Mailing Address - State:VA
Mailing Address - Zip Code:22719-2000
Mailing Address - Country:US
Mailing Address - Phone:703-346-7243
Mailing Address - Fax:
Practice Address - Street 1:2861 S F T VALLEY RD
Practice Address - Street 2:
Practice Address - City:ETLAN
Practice Address - State:VA
Practice Address - Zip Code:22719-2000
Practice Address - Country:US
Practice Address - Phone:703-346-7243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KID KONCEPTS,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001092526252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency