Healthcare Provider Details

I. General information

NPI: 1487213856
Provider Name (Legal Business Name): AUGUSTA RESOURCES FOR RESILIENCE, OPPORTUNITY,& WELLNESS-ARROW PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BYERS ST
STAUNTON VA
24401-4226
US

IV. Provider business mailing address

1011 SPRING HILL RD
STAUNTON VA
24401-2025
US

V. Phone/Fax

Practice location:
  • Phone: 540-836-9970
  • Fax:
Mailing address:
  • Phone: 540-836-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SHEPARD
Title or Position: CLINICAL DIRECTOR
Credential: LPC, NCC
Phone: 540-414-5487