Healthcare Provider Details

I. General information

NPI: 1063799260
Provider Name (Legal Business Name): PROFESSIONAL MENTAL HEALTH EDUCATIONAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 BONNIE BANK ROAD SUITE 300
RICHMOND VA
23234
US

IV. Provider business mailing address

2838 AMHERST RIDGE LOOP
COLONIAL HEIGHTS VA
23834
US

V. Phone/Fax

Practice location:
  • Phone: 804-721-0636
  • Fax: 804-541-9162
Mailing address:
  • Phone: 804-721-0636
  • Fax: 804-541-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0701003050
License Number StateVA

VIII. Authorized Official

Name: MRS. FAYE R BARNER
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 804-721-0636