Healthcare Provider Details

I. General information

NPI: 1144893785
Provider Name (Legal Business Name): KEYS TO WHOLENESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E CITY HALL AVE STE 300
NORFOLK VA
23510-1732
US

IV. Provider business mailing address

3419 VIRGINIA BEACH BLVD # 5276
VIRGINIA BEACH VA
23452-4419
US

V. Phone/Fax

Practice location:
  • Phone: 757-619-0665
  • Fax:
Mailing address:
  • Phone: 757-285-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEISHARA TAMECE HARRIS
Title or Position: OWNER
Credential: LCSW
Phone: 757-285-7922