Provider Demographics
NPI:1053891333
Name:THE MAHOGANY PROJEK, LLC
Entity type:Organization
Organization Name:THE MAHOGANY PROJEK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARDE'
Authorized Official - Middle Name:
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CCTP, LSATP
Authorized Official - Phone:323-823-8628
Mailing Address - Street 1:4012 SPRING MEADOW CRES
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3118
Mailing Address - Country:US
Mailing Address - Phone:323-823-8682
Mailing Address - Fax:
Practice Address - Street 1:4012 SPRING MEADOW CRES
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3118
Practice Address - Country:US
Practice Address - Phone:323-823-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health