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General NPI Number Information
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NPI Number | 1225637218
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Entity Type | Organization
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Legal Business Name | ENDURANCE COUNSELING AND SUPERVISION SERVICES, LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 324 LYNNHAVEN DR
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City | HAMPTON
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State | VA
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Zip | 23666-2300
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Country | US
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Telephone | 757-964-9543
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Fax | 757-964-9567
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Provider Business Mailing Address
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Address Line | 324 LYNNHAVEN DR
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City | HAMPTON
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State | VA
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Zip | 23666-2300
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Country | US
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Telephone | 757-755-3423
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Fax | 757-755-3424
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Authorized Official
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Title or Position | CEO AND MENTAL HEALTH THERAPIST
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Name | DR. JAMICIA L DAVIS
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Credential | PHD, LCSW
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Telephone | 757-755-3423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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