Healthcare Provider Details

I. General information

NPI: 1801184619
Provider Name (Legal Business Name): TKS CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 PURPLE MARTIN LN
SUFFOLK VA
23435-3329
US

IV. Provider business mailing address

241 PURPLE MARTIN LN
SUFFOLK VA
23435-3329
US

V. Phone/Fax

Practice location:
  • Phone: 757-404-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0904006264
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0904006264
License Number StateVA

VIII. Authorized Official

Name: TAQUISA SIMMONS
Title or Position: CEO
Credential:
Phone: 757-404-1900