NPI 1437590601

Phoenix Mental Health LLC

Organisation Point of Service Virginia Beach, VA

Practice location

Address: 100 S Boggs Ave, Virginia Beach, VA 23452-1705
Phone: (757) 453-4017
Mailing address: 810 Kempsville Rd STE 6, Virginia Beach, VA 23464-2723

Authorised official

Name: Richard M Mason
Title: Lpc
Phone: (757) 453-4017

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 0701003229 (VA)

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Registry record

NPI: 1437590601
Entity type: Organization
NPI issued: 16 Jul 2013
Record last updated: 22 Jul 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.