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Organization
VA SMILE FOUNDATION, INC.
Active
Organization
VA SMILE FOUNDATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENYUATIA LYNN GASH LCSW (CHIEF EXECUTIVE OFFICER)
(757) 927-7477
Entity
Organization
Contact information
Practice address
12 MUSKET LN, HAMPTON, VA 23666-5345
(757) 927-7477
(757) 654-3194
Mailing address
110 COLISEUM XING STE 5142, HAMPTON, VA 23666-5971
(757) 927-7477
(757) 654-3194
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251B00000X
Case Management Agency
—
—
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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