Healthcare Provider Details

I. General information

NPI: 1760149645
Provider Name (Legal Business Name): SK THERAPEUTICS LMFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 BROAD BEND CIRCLE
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

528 BROAD BEND CIR
CHESAPEAKE VA
23320-9290
US

V. Phone/Fax

Practice location:
  • Phone: 757-524-1636
  • Fax:
Mailing address:
  • Phone: 715-222-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH J KOOIMAN
Title or Position: OWNER/LMFT
Credential: LMFT
Phone: 715-524-1636