Provider Demographics
NPI:1669299509
Name:TOKIZAWA, KAYO
Entity type:Individual
Prefix:
First Name:KAYO
Middle Name:
Last Name:TOKIZAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHIA JUNG
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5911 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2219
Mailing Address - Country:US
Mailing Address - Phone:804-396-4048
Mailing Address - Fax:
Practice Address - Street 1:5911 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2219
Practice Address - Country:US
Practice Address - Phone:804-396-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional