ICT SERVICES INC. NPI 1619340858

NPI Information

NPI: 1619340858
Provider Name: ICT SERVICES, INC.

Former Legal Business Name: COMMONWEALTH ICT SERVICES, LLC

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
6465 COLLEGE PARK SQ STE 300
VA BEACH, VA
ZIP 23464
Phone: (757) 351-0057
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ICT SERVICES, INC. is a mental health (including community mental health center) clinic center in Va Beach, VA. ICT SERVICES, INC. NPI is 1619340858. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Commonwealth Ict Services, Llc.

The provider's business location address is:

6465 COLLEGE PARK SQ STE 300
VA BEACH, VA
ZIP 23464-622
Phone: (757) 351-0057
Fax: (757) 351-6890

The provider's authorized official is Morgan Brianna Ketner-white .
The authorized official title is Ceo, President and has the following contact phone number (757) 351-0057.

The enumeration date for this NPI number is 11/10/2015 and was last updated on 4/24/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YP2500X	Counselor	Professional	No
2	1041C0700X	Social Worker	Clinical	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	30017483470001	MEDICAID	VIRGINIA
2	16186	MEDICAID	VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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