Kedrock, Betty Alexandra

Kedrock, Betty Alexandra is an individual health care provider with primary practice located at 1709 Colley Ave Suite 312, Norfolk VA 23517-1675. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Kedrock, Betty Alexandra can be contacted via phone (757) 640-0400.

Contact Information

Primary practice address
1709 Colley Ave Suite 312 Norfolk VA 23517-1675
Phone: (757) 640-0400
Fax: (757) 640-0497
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 0904000234 Virginia

Profile Details

NPI number 1275533796
LBN Legal business name Kedrock, Betty Alexandra
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275533796 NPPES
Virginia MEDICAID 8908478
Virginia Other A163599
Virginia Other 080436
Virginia Other 324004
Virginia Other 247697
Virginia Other 049958
Virginia Other 216188
Virginia Other 5264256
Virginia Other 028883

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