Provider Demographics
NPI:1225152820
Name:THE REFUGE LLC
Entity Type:Organization
Organization Name:THE REFUGE LLC
Other - Org Name:PSYCHOTHERAPY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR AND CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-622-2660
Mailing Address - Street 1:PO BOX 11185
Mailing Address - Street 2:117 W 21ST ST SUITE 209
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517
Mailing Address - Country:US
Mailing Address - Phone:757-622-2660
Mailing Address - Fax:757-622-2661
Practice Address - Street 1:117 W 21ST ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517
Practice Address - Country:US
Practice Address - Phone:757-622-2660
Practice Address - Fax:757-622-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09040016781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80002502Medicare ID - Type Unspecified