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1215504584
KELLY MARIE RUNK
LONGVIEW, TX
NPI
1215504584
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: TX 14164)
Enumeration Date
2021-06-07
Last Update Date
2021-06-07
Business Address
KELLY MARIE RUNK LCDC
950 N 4TH ST
LONGVIEW, TX 75601-5436
Phone number: 903-758-2471
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Mailing Address
KELLY MARIE RUNK LCDC
107 WOODBINE PL
LONGVIEW, TX 75601-2912
Phone number: 903-758-2471
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