Provider Demographics
NPI:1700657764
Name:K'QUEENDOM MENTORING
Entity Type:Organization
Organization Name:K'QUEENDOM MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ME'KIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-C
Authorized Official - Phone:757-778-3535
Mailing Address - Street 1:4710 ASHBURY LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7221
Mailing Address - Country:US
Mailing Address - Phone:757-778-3535
Mailing Address - Fax:
Practice Address - Street 1:4710 ASHBURY LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7221
Practice Address - Country:US
Practice Address - Phone:757-778-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty