Provider Demographics
NPI:1982410510
Name:HERNANDEZ, KEVIN ARNULFO
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ARNULFO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MAYFLOWER RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2750
Mailing Address - Country:US
Mailing Address - Phone:703-454-4228
Mailing Address - Fax:
Practice Address - Street 1:1403 GREENBRIER PKWY STE 225
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0752
Practice Address - Country:US
Practice Address - Phone:775-758-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health