Provider Demographics
NPI:1619676806
Name:REFUGE COVE COUNSELING, LLC
Entity Type:Organization
Organization Name:REFUGE COVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-841-3910
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE B292
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7373
Mailing Address - Country:US
Mailing Address - Phone:907-841-3910
Mailing Address - Fax:
Practice Address - Street 1:892 E USA CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7106
Practice Address - Country:US
Practice Address - Phone:907-841-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty