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Certified Provider Details:
| PROVIDER NUMBER: | 490039 |
| AGENCY NAME: | Kanawha Valley Center |
| CONTACT NAME: | Kristi Ferrell |
| ADDRESS: | 200 Bradford Street |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25301 |
| PHONE: | |
| WEB SITE: | |
| EMAIL ADDRESS: | krferrell@kvc.org |
| BSW/MSW NAME: | Amy Miller Hamrick |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |