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General NPI Number Information
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NPI Number | 1205445327
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Entity Type | Organization
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Legal Business Name | KAM VIRTUAL THERAPEUTIC SERVICES INC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 11266 LAKE MANDARIN CIR E
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7811
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Country | US
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Telephone | 904-705-6130
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Fax |
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Provider Business Mailing Address
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Address Line | 7643 GATE PKWY STE 104-941
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2893
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Country | US
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Telephone | 904-720-2090
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Fax | 904-490-9998
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KELLY ANN MINOR
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Credential | LCSW
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Telephone | 904-720-2090
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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 |
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License Number State |
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