Provider Demographics
NPI:1407126485
Name:SAFE HARBOR CHRISTIAN COUNSELING OF HAMPTON ROADS LLC
Entity Type:Organization
Organization Name:SAFE HARBOR CHRISTIAN COUNSELING OF HAMPTON ROADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-569-9497
Mailing Address - Street 1:728 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5843
Mailing Address - Country:US
Mailing Address - Phone:757-354-0620
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:728 OXFORD DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5843
Practice Address - Country:US
Practice Address - Phone:757-354-0620
Practice Address - Fax:410-569-0094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE HARBOR CHRISTIAN COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty