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General NPI Number Information
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NPI Number | 1760149645
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Entity Type | Organization
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Legal Business Name | SK THERAPEUTICS LMFT, LLC
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 528 BROAD BEND CIRCLE
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-524-1636
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Fax |
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Provider Business Mailing Address
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Address Line | 528 BROAD BEND CIR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-9290
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Country | US
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Telephone | 715-222-9002
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Fax |
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Authorized Official
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Title or Position | OWNER/LMFT
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Name | SARAH J KOOIMAN
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Credential | LMFT
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Telephone | 715-524-1636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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