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General NPI Number Information
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NPI Number | 1861980260
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Entity Type | Organization
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Legal Business Name | SPIRITUALLY INSPIRED TRANSFORMATION SERVICES
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 104 WEXFORD CT
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City | YORKTOWN
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State | VA
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Zip | 23693-4597
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Country | US
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Telephone | 757-300-7099
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WEXFORD CT
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City | YORKTOWN
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State | VA
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Zip | 23693-4597
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Country | US
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Telephone | 757-300-7099
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING CONSULTANT
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Name | YAISA GOODWIN
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Credential |
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Telephone | 757-339-8798
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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 | 0904009647
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License Number State | VA
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