Provider Demographics
NPI:1568031706
Name:PENINSULA OUTREACH FAMILY COUNSELING LLC
Entity Type:Organization
Organization Name:PENINSULA OUTREACH FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEQWANA
Authorized Official - Middle Name:GENEVA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-835-1799
Mailing Address - Street 1:1915 SEWARD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-1122
Mailing Address - Country:US
Mailing Address - Phone:804-835-1799
Mailing Address - Fax:
Practice Address - Street 1:1915 SEWARD DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1122
Practice Address - Country:US
Practice Address - Phone:804-835-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty