Healthcare Provider Details

I. General information

NPI: 1841711066
Provider Name (Legal Business Name): KEVIN SCOTT SEARS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 OLD CART RD
WILLIAMSBURG VA
23188-7811
US

IV. Provider business mailing address

206 OLD CART RD
WILLIAMSBURG VA
23188-7811
US

V. Phone/Fax

Practice location:
  • Phone: 757-376-1094
  • Fax:
Mailing address:
  • Phone: 757-376-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1657
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: