Healthcare Provider Details

I. General information

NPI: 1407786205
Provider Name (Legal Business Name): KNK CLINICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 BERNIES CT S
CHESAPEAKE VA
23321-5236
US

IV. Provider business mailing address

110 COLISEUM XING UNIT 786
HAMPTON VA
23666-5971
US

V. Phone/Fax

Practice location:
  • Phone: 757-609-5690
  • Fax:
Mailing address:
  • Phone: 757-609-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENDRA N KABONGO-FAROUL
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 757-715-1263