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General NPI Number Information
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NPI Number | 1518732965
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Entity Type | Organization
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Legal Business Name | REFUEL LIFE TRAUMA CENTER, LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 100 SABAL PALM LN APT 303
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1734
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Country | US
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Telephone | 757-288-8794
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SABAL PALM LN APT 303
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1734
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Country | US
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Telephone | 757-288-8794
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | PATRICE DANIELLE MURPHY
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Credential | LPC, NCC
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Telephone | 757-453-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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