Provider Demographics
NPI:1629518121
Name:JKT TRAUMA CONSULTATION COUNSELING AND TRAINING SERVICES
Entity Type:Organization
Organization Name:JKT TRAUMA CONSULTATION COUNSELING AND TRAINING SERVICES
Other - Org Name:JKT SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:DUNGEE- ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-840-1149
Mailing Address - Street 1:1901 HUGUENOT RD STE 303
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4311
Mailing Address - Country:US
Mailing Address - Phone:804-794-6247
Mailing Address - Fax:804-794-6247
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:STE 303
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-794-6247
Practice Address - Fax:804-794-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000543251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health