Healthcare Provider Details

I. General information

NPI: 1750059044
Provider Name (Legal Business Name): PHASES THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E MAIN ST STE 104
RICHMOND VA
23223-7072
US

IV. Provider business mailing address

2025 E MAIN ST STE 104
RICHMOND VA
23223-7072
US

V. Phone/Fax

Practice location:
  • Phone: 804-220-0433
  • Fax: 540-492-5592
Mailing address:
  • Phone: 804-220-0433
  • Fax: 540-492-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAT DEVEREAUX
Title or Position: LPC
Credential: LPC
Phone: 804-220-0433