Provider Demographics
NPI:1629807052
Name:FAMILIES ORGANIZED FOR RENEWAL AND COMMUNITY EMPOWERMENT
Entity type:Organization
Organization Name:FAMILIES ORGANIZED FOR RENEWAL AND COMMUNITY EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESONIJA
Authorized Official - Middle Name:SHAVON
Authorized Official - Last Name:FULGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:202-494-6119
Mailing Address - Street 1:3575 BRIDGE RD # 612
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1800
Mailing Address - Country:US
Mailing Address - Phone:202-494-6119
Mailing Address - Fax:
Practice Address - Street 1:4037 TAYLOR RD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5500
Practice Address - Country:US
Practice Address - Phone:202-494-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty