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General NPI Number Information
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NPI Number | 1710758347
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Entity Type | Organization
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Legal Business Name | THE KNOWN HEART LLC
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 513 FOREST AVE STE 203
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City | RICHMOND
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State | VA
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Zip | 23229-6850
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Country | US
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Telephone | 206-886-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3671
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Country | US
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Telephone | 206-886-8733
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. ATHENA BREWER
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Credential | MA, LMFT
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Telephone | 206-886-8733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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