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General NPI Number Information
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NPI Number | 1013300946
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR PSYCHOLOGICAL & HEALTH DEVELOPMENT
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 5388 DISCOVERY PARK BLVD SUITE 110 A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8218
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Country | US
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Telephone | 757-903-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 5388 DISCOVERY PARK BLVD SUITE 110 A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8218
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Country | US
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Telephone | 757-903-5752
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MARIA KOKOLIS
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Credential |
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Telephone | 757-592-2098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701005678
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License Number State | VA
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