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General NPI Number Information
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NPI Number | 1912363698
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Entity Type | Organization
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Legal Business Name | KINGA GUDOR
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 129 W VIRGINIA BEACH BLVD STE 204A
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City | NORFOLK
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State | VA
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Zip | 23510-2030
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Country | US
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Telephone | 757-319-5416
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Fax | 757-918-8760
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Provider Business Mailing Address
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Address Line | 1146 ROCKBRIDGE AVE
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City | NORFOLK
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State | VA
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Zip | 23508-1418
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Country | US
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Telephone | 757-319-5416
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Fax | 757-918-8760
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Authorized Official
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Title or Position | OWNER
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Name | KINGA GUDOR
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Credential | LCSW, PHD
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Telephone | 757-319-5416
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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 | 0904007315
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License Number State | VA
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