Healthcare Provider Details

I. General information

NPI: 1023913100
Provider Name (Legal Business Name): MAKENSEY S KING QMHP-A, CSAC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 INNOVATION DR STE 102
CHESAPEAKE VA
23320-3866
US

IV. Provider business mailing address

9563 9TH BAY ST APT B
NORFOLK VA
23518-1296
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-3278
  • Fax:
Mailing address:
  • Phone: 757-790-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: