Healthcare Provider Details

I. General information

NPI: 1124312806
Provider Name (Legal Business Name): K.I. SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S. QUAKER LANE SUITE 4
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

25 S. QUAKER LANE SUITE 4
ALEXANDRIA VA
22314
US

V. Phone/Fax

Practice location:
  • Phone: 703-823-4401
  • Fax: 703-823-4407
Mailing address:
  • Phone: 703-823-4401
  • Fax: 703-823-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: YVONNE VIRGINIA WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-823-4401