Provider Demographics
NPI:1841790961
Name:KB PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:KB PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINCAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-488-9840
Mailing Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 230
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3095
Mailing Address - Country:US
Mailing Address - Phone:571-488-9840
Mailing Address - Fax:571-488-9841
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3095
Practice Address - Country:US
Practice Address - Phone:571-488-9840
Practice Address - Fax:571-488-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004667261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)