=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881328128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSEVERING FAMILIES & COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2022
-----------------------------------------------------
Last Update Date | 07/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 INNOVATION DR STE 304
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-577-2100
-----------------------------------------------------
Fax | 757-304-9423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 GARDNER ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23851-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-577-2100
-----------------------------------------------------
Fax | 757-304-9423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JANICE A HOLEMON
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 757-577-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------