Individual
KINSHASA BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
192 BALLARD CT STE 105, VIRGINIA BEACH, VA 23462-6538
(757) 904-0444
(757) 866-5824
Mailing address
PO BOX 748465, ATLANTA, GA 30374-8465
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701015302
VA
101YP2500X
Professional Counselor
Primary
0704013088
VA
Other
Enumeration date
09/07/2023
Last updated
03/08/2026
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