Healthcare Provider Details

I. General information

NPI: 1992153316
Provider Name (Legal Business Name): MARINA KUZMINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6604
US

IV. Provider business mailing address

2202 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7707
  • Fax: 757-838-2573
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006459
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: