| Ict Services, Inc. | |
|
6465 College Park Sq Ste 300 Va Beach VA 23464-3622 | |
| (757) 351-0057 | |
| (757) 351-6890 |
| Full Name | Ict Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6465 College Park Sq Ste 300, Va Beach, Virginia |
| Authorized Official Name and Position | Morgan Brianna Ketner-white (CEO, PRESIDENT) |
| Authorized Official Contact | 7573510057 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ict Services, Inc. 6465 College Park Sq Ste 300 Va Beach VA 23464-3622 Ph: (757) 351-0005 | Ict Services, Inc. 6465 College Park Sq Ste 300 Va Beach VA 23464-3622 Ph: (757) 351-0057 |
| NPI Number | 1619340858 |
|---|---|
| Provider Enumeration Date | 11/10/2015 |
| Last Update Date | 09/16/2024 |
| Certification Date | 09/16/2024 |
| Medicare PECOS PAC ID | 2163964925 |
|---|---|
| Medicare Enrollment ID | O20240607001250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619340858 | NPI | - | NPPES |
| 30017483470002 | Medicaid | VA | |
| 16186 | Medicaid | VA | |
| 30017483470001 | Medicaid | VA |
| Provider Name | Shelly Marie Rodgers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790567394 PECOS PAC ID: 3072055839 Enrollment ID: I20240607001338 |
| Provider Name | Morgan Brianna Ketner-white |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619759297 PECOS PAC ID: 7517409378 Enrollment ID: I20240607001677 |
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