Individual
KENNETH FRALEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHP-A, CSAC-S
Contact information
Practice address
2790 GODWIN BLVD STE 200, SUFFOLK, VA 23434-8151
(866) 934-7450
Mailing address
1773 CHASE POINTE CIR APT 527, VIRGINIA BEACH, VA 23454-7046
(843) 319-1228
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0709025201
VA
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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