Healthcare Provider Details

I. General information

NPI: 1427518463
Provider Name (Legal Business Name): KIMBERLY HETSKO M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LYNNHAVEN PKWY STE 400
VIRGINIA BEACH VA
23452-7332
US

IV. Provider business mailing address

780 LYNNHAVEN PKWY STE 400
VIRGINIA BEACH VA
23452-7332
US

V. Phone/Fax

Practice location:
  • Phone: 757-266-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002071
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH003711
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: