Provider Demographics
NPI:1558138453
Name:CHARIS MENTAL HEALTH PLUS INTEGRATIVE CARE
Entity Type:Organization
Organization Name:CHARIS MENTAL HEALTH PLUS INTEGRATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:DR
Authorized Official - First Name:LA KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENETI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PMH-BC
Authorized Official - Phone:757-922-8048
Mailing Address - Street 1:2470 PRUDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4206
Mailing Address - Country:US
Mailing Address - Phone:757-922-8048
Mailing Address - Fax:757-922-8049
Practice Address - Street 1:2470 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4206
Practice Address - Country:US
Practice Address - Phone:757-922-8048
Practice Address - Fax:757-922-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty