Provider Demographics
NPI:1932209863
Name:BALLINA, KAY COLLINS (MA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:COLLINS
Last Name:BALLINA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:304-766-6700
Mailing Address - Fax:304-766-6118
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1111000000Medicaid