Provider Demographics
NPI:1043515331
Name:WARD, KAWANNA EVETTE (LCSW, CSAC, CSOTP)
Entity type:Individual
Prefix:MS
First Name:KAWANNA
Middle Name:EVETTE
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW, CSAC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 LONDON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2137
Mailing Address - Country:US
Mailing Address - Phone:757-966-1889
Mailing Address - Fax:
Practice Address - Street 1:1634 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2137
Practice Address - Country:US
Practice Address - Phone:757-966-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000607101Y00000X
VA0710102377101YA0400X
VA09040075341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)