Healthcare Provider Details

I. General information

NPI: 1447744669
Provider Name (Legal Business Name): VIRTUE STANDARDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 W SCHOOL ST
RIDGELAND MS
39157
US

IV. Provider business mailing address

234 W SCHOOL ST
RIDGELAND MS
39157-2707
US

V. Phone/Fax

Practice location:
  • Phone: 601-497-7551
  • Fax: 601-510-9291
Mailing address:
  • Phone: 601-497-7551
  • Fax: 601-510-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberC9283
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberC9283
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberC9283
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberC9283
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC9283
License Number StateMS

VIII. Authorized Official

Name: ROGENIA PARKER
Title or Position: OWNER
Credential: CLINICAL SOCIAL WORK
Phone: 601-497-7551