Healthcare Provider Details

I. General information

NPI: 1730617002
Provider Name (Legal Business Name): MRS. SHARDE' O'ROURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CLEVELAND PL STE B
VIRGINIA BEACH VA
23462-6529
US

IV. Provider business mailing address

4012 SPRING MEADOW CRES
CHESAPEAKE VA
23321-3118
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: