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General NPI Number Information
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NPI Number | 1487213856
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Entity Type | Organization
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Legal Business Name | AUGUSTA RESOURCES FOR RESILIENCE, OPPORTUNITY,& WELLNESS-ARROW PROJECT
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 10 BYERS ST
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City | STAUNTON
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State | VA
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Zip | 24401-4226
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Country | US
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Telephone | 540-836-9970
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 SPRING HILL RD
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City | STAUNTON
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State | VA
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Zip | 24401-2025
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Country | US
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Telephone | 540-836-9970
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CHARLES SHEPARD
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Credential | LPC, NCC
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Telephone | 540-414-5487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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