Provider Demographics
NPI:1750749735
Name:Q'S AND POETIC'S SPECIAL EDUCATION AND FAMILY SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:Q'S AND POETIC'S SPECIAL EDUCATION AND FAMILY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:AAPSY,BSHS/M,QMHP
Authorized Official - Phone:757-775-1612
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 201D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4510
Mailing Address - Country:US
Mailing Address - Phone:757-591-8400
Mailing Address - Fax:757-591-0900
Practice Address - Street 1:610 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 201D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4510
Practice Address - Country:US
Practice Address - Phone:757-591-8400
Practice Address - Fax:757-591-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:Q'S AND POETIC'S SPECIAL EDUCATION AND FAMILY SUPPORT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2640251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health