Healthcare Provider Details

I. General information

NPI: 1760317374
Provider Name (Legal Business Name): MRS. KRYSTAL WILLIAMS SWEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 COLUMBUS ST UNIT 61601
VIRGINIA BEACH VA
23466-1253
US

IV. Provider business mailing address

4831 COLUMBUS ST UNIT 61601
VIRGINIA BEACH VA
23466-1253
US

V. Phone/Fax

Practice location:
  • Phone: 756-309-3686
  • Fax:
Mailing address:
  • Phone: 756-309-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1898202008
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: