Healthcare Provider Details

I. General information

NPI: 1962264960
Provider Name (Legal Business Name): PETERSONS EMPOWERMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

IV. Provider business mailing address

1545 CROSSWAYS BLVD STE 250
CHESAPEAKE VA
23320-0218
US

V. Phone/Fax

Practice location:
  • Phone: 757-718-3371
  • Fax:
Mailing address:
  • Phone: 757-718-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DONITA SADE' PETERSON
Title or Position: OWNER/ CEO
Credential: MSW, LMHP-S
Phone: 757-718-3371