Healthcare Provider Details

I. General information

NPI: 1033642665
Provider Name (Legal Business Name): THE LEARNING AND INTEGRATING NEW KNOWLEDGE AND SKILLS CENTER, INC. (T
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 COMMERCE ST
PETERSBURG VA
23803-3003
US

IV. Provider business mailing address

PO BOX 2583
PETERSBURG VA
23804-2583
US

V. Phone/Fax

Practice location:
  • Phone: 804-919-0526
  • Fax:
Mailing address:
  • Phone: 804-919-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: SARAH L SMOOT
Title or Position: EXECUTIVE DIRECTOR
Credential: QMHP,CPSP
Phone: 804-919-0526