Healthcare Provider Details

I. General information

NPI: 1760291264
Provider Name (Legal Business Name): KWASHEE TOTIMEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14421 GENERAL WASHINGTON DR
WOODBRIDGE VA
22193-3254
US

IV. Provider business mailing address

14421 GENERAL WASHINGTON DR
WOODBRIDGE VA
22193-3254
US

V. Phone/Fax

Practice location:
  • Phone: 610-803-7353
  • Fax:
Mailing address:
  • Phone: 610-803-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: