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General NPI Number Information
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NPI Number | 1114210358
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Entity Type | Individual
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Provider Name | SANDRA M KINSNER LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 289 INDEPENDENCE BLVD STE 138
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5493
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Country | US
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Telephone | 757-385-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 321 HUTTON CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3900
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Country | US
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Telephone | 757-425-0181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007448
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License Number State | VA
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