=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316321128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATCH KEY PROJECTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2015
-----------------------------------------------------
Last Update Date | 07/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1157 S MILITARY HWY SUITE 202-B
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-424-2357
-----------------------------------------------------
Fax | 757-424-2316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17577 BEALE PLACE DR
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23487-8345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-424-2357
-----------------------------------------------------
Fax | 757-424-2316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARY PATRICIA BILLS
-----------------------------------------------------
Credential | CSAC
-----------------------------------------------------
Telephone | 757-424-2357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701000838
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0710101904
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------