Organization
FAMILIES ORGANIZED FOR RENEWAL AND COMMUNITY EMPOWERMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESONIJA SHAVON FULGHAM LCSW (DIRECTOR/OWNER)
(202) 494-6119
Entity
Organization
Contact information
Practice address
4037 TAYLOR RD STE C, CHESAPEAKE, VA 23321-5500
(202) 494-6119
Mailing address
3575 BRIDGE RD # 612, SUFFOLK, VA 23435-1800
(202) 494-6119
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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