Healthcare Provider Details

I. General information

NPI: 1679051692
Provider Name (Legal Business Name): KYLIE TAMIKO DEGUZMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLIE TAMIKO GUMBAN MA

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 CLAIBORNE SQ E # 234
HAMPTON VA
23666-2071
US

IV. Provider business mailing address

4410 CLAIBORNE SQ E # 234
HAMPTON VA
23666-2071
US

V. Phone/Fax

Practice location:
  • Phone: 757-977-0889
  • Fax: 757-977-0895
Mailing address:
  • Phone: 757-977-0889
  • Fax: 757-977-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016744
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: