Organization
HOUSE OF REFUGE RESTORATION, LLC
Active
Other names
House of refuge
Organization subpart
No
Provider details
NPI number
Authorized official
TEISHA ETHERIDGE BS (PROGRAM DIRECTOR)
(757) 560-1944
Entity
Organization
Contact information
Practice address
805 SHADOWBERRY CRST, CHESAPEAKE, VA 23320-3544
(757) 560-1944
(877) 468-5361
Mailing address
805 SHADOWBERRY CRST, CHESAPEAKE, VA 23320-3544
(757) 560-1944
(877) 468-5361
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0710102115
VA
101Y00000X
Counselor
0812000532
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102115
VA
1041C0700X
Clinical Social Worker
Primary
0904006954
VA
Other
Enumeration date
06/16/2009
Last updated
06/16/2009
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