Provider Demographics
NPI:1336198381
Name:LINTON, KERRI ANN (MA)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:LINTON
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 1:202 GLASS DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1319
Mailing Address - Country:US
Mailing Address - Phone:304-776-7230
Mailing Address - Fax:304-776-7247
Practice Address - Street 1:313 MARKET RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7116
Practice Address - Country:US
Practice Address - Phone:304-254-9003
Practice Address - Fax:304-254-9005
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1521101YM0800X
WV852103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9202149000Medicaid