Provider Demographics
NPI:1033663158
Name:ASPIRE PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:ASPIRE PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KINISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:757-344-0127
Mailing Address - Street 1:PO BOX 2172
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-2172
Mailing Address - Country:US
Mailing Address - Phone:757-648-1361
Mailing Address - Fax:757-648-1361
Practice Address - Street 1:4605 PEMBROKE LAKE CIR
Practice Address - Street 2:103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6434
Practice Address - Country:US
Practice Address - Phone:757-344-0127
Practice Address - Fax:757-648-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty