Provider Demographics
NPI:1255011102
Name:BASNIGHT, KORD HALL (RESIDENT IN COUNSELI)
Entity type:Individual
Prefix:
First Name:KORD
Middle Name:HALL
Last Name:BASNIGHT
Suffix:
Gender:M
Credentials:RESIDENT IN COUNSELI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 OAK STREAM CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2650
Mailing Address - Country:US
Mailing Address - Phone:703-861-6639
Mailing Address - Fax:
Practice Address - Street 1:9525 OAK STREAM CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2650
Practice Address - Country:US
Practice Address - Phone:703-861-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015863101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor