Healthcare Provider Details

I. General information

NPI: 1003636895
Provider Name (Legal Business Name): SKMY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8241 SIMONS DR
NORFOLK VA
23505-1644
US

IV. Provider business mailing address

8241 SIMONS DR
NORFOLK VA
23505-1644
US

V. Phone/Fax

Practice location:
  • Phone: 757-650-6897
  • Fax:
Mailing address:
  • Phone: 757-650-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARA YOUNG
Title or Position: OWNER
Credential: LPC
Phone: 757-650-6897