Healthcare Provider Details

I. General information

NPI: 1801766142
Provider Name (Legal Business Name): WARRIORS REFUGE AND RESTORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 INDIAN CREEK RD NW
WILLIS VA
24380-4506
US

IV. Provider business mailing address

341 INDIAN CREEK RD NW
WILLIS VA
24380-4506
US

V. Phone/Fax

Practice location:
  • Phone: 540-808-3380
  • Fax:
Mailing address:
  • Phone: 540-808-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DARA SHORT
Title or Position: FOUNDER/DIRECTOR
Credential:
Phone: 540-808-3380