Provider Demographics
NPI:1104436534
Name:AGAPE ANGELS RESOULTION SERVICES, LLC
Entity type:Organization
Organization Name:AGAPE ANGELS RESOULTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SHUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:ABD
Authorized Official - Phone:804-919-0364
Mailing Address - Street 1:2 FLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4613
Mailing Address - Country:US
Mailing Address - Phone:804-919-0364
Mailing Address - Fax:
Practice Address - Street 1:1430 FARMER ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3941
Practice Address - Country:US
Practice Address - Phone:804-919-0364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPOWERED COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health