Healthcare Provider Details

I. General information

NPI: 1619340858
Provider Name (Legal Business Name): ICT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 COLLEGE PARK SQ STE 300
VA BEACH VA
23464-3622
US

IV. Provider business mailing address

6465 COLLEGE PARK SQ STE 300
VA BEACH VA
23464-3622
US

V. Phone/Fax

Practice location:
  • Phone: 757-351-0057
  • Fax: 757-351-6890
Mailing address:
  • Phone: 757-351-0005
  • Fax: 757-351-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MORGAN BRIANNA KETNER-WHITE
Title or Position: CEO, PRESIDENT
Credential:
Phone: 757-351-0057