Organization
THE KENNEDY GROUP OUTPATIENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEONKO SAMPSON (CEO)
(757) 722-1800
Entity
Organization
Contact information
Practice address
112 KINGS WAY, HAMPTON, VA 23669-3500
(757) 722-1800
(757) 722-1900
Mailing address
112 KINGS WAY, HAMPTON, VA 23669-3500
(757) 722-1800
(757) 722-1900
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/26/2017
Last updated
07/21/2022
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