| Organization Name: | HOUSE OF REFUGE RESTORATION, LLC |
| NPI Number: | 1124255260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TEISHA ETHERIDGE (PROGRAM DIRECTOR) |
| Mailing Address: | 805 Shadowberry Crst Chesapeake |
| State: | VA US |
| Postal Code: | 233203544 |
| Phone Number: | 7575601944 |
| Fax Number: | 8774685361 |
| NPI Enumeration Date: | 06/16/2009 |
| NPI Last Update Date: | 06/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 0812000532 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |