Healthcare Provider Details

I. General information

NPI: 1952977217
Provider Name (Legal Business Name): ISSACHAR K TIGRE CHINNERY FOUNDATION-VICTIMS UNITED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#19 NORRE GADE STE 3
ST. THOMAS VI
00802
US

IV. Provider business mailing address

6313 ESTATE WINTBERG
ST THOMAS VI
00802-3463
US

V. Phone/Fax

Practice location:
  • Phone: 340-642-5204
  • Fax:
Mailing address:
  • Phone: 340-642-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. BERNADETTE PATRICIA GONSALVES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 340-642-5204