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General NPI Number Information
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NPI Number | 1477079408
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Entity Type | Organization
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Legal Business Name | KIDS KIN N CAREGIVERS
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 6300 E VIRGINIA BEACH BLVD
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City | NORFOLK
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State | VA
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Zip | 23502-2827
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Country | US
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Telephone | 757-434-5162
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 LYNNHAVEN PKWY STE 106-315
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1497
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Country | US
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Telephone | 757-434-5162
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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 | DR. KATHY L DIAL
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Credential | PHD
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Telephone | 757-434-5162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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