Healthcare Provider Details

I. General information

NPI: 1518876820
Provider Name (Legal Business Name): ASCENDING PHOENIX SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 BAXTER RD
DISPUTANTA VA
23842-3801
US

IV. Provider business mailing address

1601 WILLOW LAWN DRIVE STE 304 BOX # 1202
RICHMOND VA
23230
US

V. Phone/Fax

Practice location:
  • Phone: 757-362-6691
  • Fax:
Mailing address:
  • Phone: 757-362-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: OZZIE RICHARD DELOACH
Title or Position: CFO/ CHIEF FINANCIAL OFFICER
Credential:
Phone: 757-362-6691