| Mdk Llc | |
|
3111 Northside Ave Ste 101 Henrico VA 23228-5441 | |
| (804) 366-4330 | |
| Not Available |
| Full Name | Mdk Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3111 Northside Ave Ste 101, Henrico, Virginia |
| Authorized Official Name and Position | Monica D Klisz (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 8043664330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mdk Llc 3111 Northside Ave Ste 101 Henrico VA 23228-5441 Ph: (804) 366-4330 | Mdk Llc 3111 Northside Ave Ste 101 Henrico VA 23228-5441 Ph: (804) 366-4330 |
| NPI Number | 1205606514 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 02/21/2024 |
| Certification Date | 02/21/2024 |
| Medicare PECOS PAC ID | 8729422795 |
|---|---|
| Medicare Enrollment ID | O20240217000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205606514 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Monica D Klisz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720261761 PECOS PAC ID: 9638513609 Enrollment ID: I20240217000015 |
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