Provider Demographics
NPI:1225637218
Name:ENDURANCE COUSNELING AND SUPERVISION SERVICES,LLC
Entity Type:Organization
Organization Name:ENDURANCE COUSNELING AND SUPERVISION SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-964-9543
Mailing Address - Street 1:1706 TODDS LN # 275
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3123
Mailing Address - Country:US
Mailing Address - Phone:757-964-9543
Mailing Address - Fax:757-964-9567
Practice Address - Street 1:324 LYNNHAVEN DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2300
Practice Address - Country:US
Practice Address - Phone:757-964-9543
Practice Address - Fax:757-964-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health