Provider Demographics
NPI:1235804006
Name:FOUNDATIONS SUPPORTIVE SERVICES LLC
Entity Type:Organization
Organization Name:FOUNDATIONS SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-329-3662
Mailing Address - Street 1:11834 CANON BLVD STE J3-4
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2581
Mailing Address - Country:US
Mailing Address - Phone:757-329-3662
Mailing Address - Fax:
Practice Address - Street 1:11834 CANON BLVD STE J3-4
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2581
Practice Address - Country:US
Practice Address - Phone:757-329-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARTER COUNSELING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health