Provider Demographics
NPI:1245000421
Name:TERRELONGE, KECIA MONIQUE
Entity type:Individual
Prefix:MS
First Name:KECIA
Middle Name:MONIQUE
Last Name:TERRELONGE
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 1:1024 CENTERBROOKE LN STE F136
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8291
Mailing Address - Country:US
Mailing Address - Phone:804-868-5518
Mailing Address - Fax:
Practice Address - Street 1:908 W WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6252
Practice Address - Country:US
Practice Address - Phone:804-868-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)