Healthcare Provider Details

I. General information

NPI: 1063036077
Provider Name (Legal Business Name): FIRST RESPONDERS AND MILITARY EMPOWERMENT SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25328 DICKENS LN
CAPRON VA
23829-2020
US

IV. Provider business mailing address

25328 DICKENS LN
CAPRON VA
23829-2020
US

V. Phone/Fax

Practice location:
  • Phone: 757-556-7551
  • Fax:
Mailing address:
  • Phone: 757-556-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELIA DAWN DICKENS
Title or Position: FOUNDER/DIRECTOR
Credential: LPC, LMFT
Phone: 757-556-7551