Healthcare Provider Details

I. General information

NPI: 1760317770
Provider Name (Legal Business Name): KINKY TRAP X TRAP KINK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9273 1ST VIEW ST
NORFOLK VA
23503-4225
US

IV. Provider business mailing address

9273 1ST VIEW ST
NORFOLK VA
23503-4225
US

V. Phone/Fax

Practice location:
  • Phone: 757-895-1837
  • Fax:
Mailing address:
  • Phone: 757-895-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SIERRA JOHNSON
Title or Position: OWNER
Credential: LPC
Phone: 757-895-1837