MEDICARE: ASPIRE PROFESSIONAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033663158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE PROFESSIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 2172
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-2172
Country	:	US
Telephone Number	:	757-648-1361
Fax Number	:	757-648-1361

Provider Business Practice Location Address
First Line	:	4605 PEMBROKE LAKE CIR
Second Line	:	103
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6434
Country	:	US
Telephone Number	:	757-344-0127
Fax Number	:	757-648-1361

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS KINISHA GREENE
Credential	:	MSW
Telephone Number	:	757-344-0127

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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