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General NPI Number Information
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NPI Number | 1033642665
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Entity Type | Organization
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Legal Business Name | THE LEARNING AND INTEGRATING NEW KNOWLEDGE AND SKILLS CENTER, INC. (T
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 827 COMMERCE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3003
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Country | US
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Telephone | 804-919-0526
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2583
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City | PETERSBURG
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State | VA
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Zip | 23804-2583
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Country | US
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Telephone | 804-919-0526
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SARAH L SMOOT
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Credential | QMHP,CPSP
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Telephone | 804-919-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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