Healthcare Provider Details

I. General information

NPI: 1699384149
Provider Name (Legal Business Name): KL GASH & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MUSKET LN
HAMPTON VA
23666-5345
US

IV. Provider business mailing address

5336 GEORGE WASHINGTON MEM HWY STE E1
YORKTOWN VA
23692-2501
US

V. Phone/Fax

Practice location:
  • Phone: 412-401-9707
  • Fax:
Mailing address:
  • Phone: 757-344-3848
  • Fax: 718-732-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KENYUATIA L GASH
Title or Position: CEO AND CLINICAL DIRECTOR
Credential: LCSW
Phone: 757-344-3848