=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033823018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADIGM MENTAL HEALTH SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2023
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4112 PRITCHARD STREET SUFFOLK VA. 23435
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-957-2098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4112 PRITCHARD STREET SUFFOLK VA. 23435
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-957-2098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MARY MCKAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-957-2098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------