Healthcare Provider Details

I. General information

NPI: 1144033622
Provider Name (Legal Business Name): VONDA KAYE SESSOMS GREENE QMHP, CSAC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N MECHANIC ST # 224
FRANKLIN VA
23851-1455
US

IV. Provider business mailing address

21398 BUCKHORN QUARTER RD
COURTLAND VA
23837-2416
US

V. Phone/Fax

Practice location:
  • Phone: 757-567-5854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0711000736
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0732006194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: