Provider Demographics
NPI:1487213856
Name:AUGUSTA RESOURCES FOR RESILIENCE, OPPORTUNITY,& WELLNESS-ARROW PROJECT
Entity Type:Organization
Organization Name:AUGUSTA RESOURCES FOR RESILIENCE, OPPORTUNITY,& WELLNESS-ARROW PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:540-414-5487
Mailing Address - Street 1:1011 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2025
Mailing Address - Country:US
Mailing Address - Phone:540-836-9970
Mailing Address - Fax:
Practice Address - Street 1:10 BYERS ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4226
Practice Address - Country:US
Practice Address - Phone:540-836-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty