Provider Demographics
NPI:1013300946
Name:INSTITUTE FOR PSYCHOLOGICAL & HEALTH DEVELOPMENT
Entity Type:Organization
Organization Name:INSTITUTE FOR PSYCHOLOGICAL & HEALTH DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-592-2098
Mailing Address - Street 1:5388 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 110 A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8218
Mailing Address - Country:US
Mailing Address - Phone:757-903-5752
Mailing Address - Fax:
Practice Address - Street 1:5388 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 110 A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8218
Practice Address - Country:US
Practice Address - Phone:757-903-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty