Provider Demographics
NPI:1174222558
Name:CHARITY, KAYANNA
Entity type:Individual
Prefix:
First Name:KAYANNA
Middle Name:
Last Name:CHARITY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 PUMPKIN SEED LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5957
Mailing Address - Country:US
Mailing Address - Phone:804-836-5337
Mailing Address - Fax:
Practice Address - Street 1:1508 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-1539
Practice Address - Country:US
Practice Address - Phone:804-836-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty